Outcomes of stereotactic radiosurgery for pituitary metastases: an international multi-institutional study

Hussam Abou-Al-Shaar¹, Ibrahem Albalkhi², Rimsha K Shariff³, Arka N Mallela², Pouneh K Fazeli³, Salem M Tos⁴, Georgios Mantziaris⁴, Ying Meng⁵, Kenneth Bernstein⁶, Tehila Kaisman-Elbaz⁷, Hanan Abofani⁷, Yen-Yu Lin⁸, Cheng-Chia Lee⁸, Manjul Tripathi⁹, Rituraj Upadhyay¹⁰, Joshua D Palmer¹⁰, Ahmed M Nabeel^{11

12}, Wael A Reda^{11

12}, Sameh R Tawadros^{11

12}, Khaled Abdelkarim^{11

13}, Amr M N El-Shehaby^{11

12}, Reem M Emad^{11

14}, Selcuk Peker¹⁵, Yavuz Samanci¹⁵, Rodney E Wegner¹⁶, Matthew J Shepard¹⁷, Roman Liscak¹⁸, Gabriela Simonova¹⁹, Timoteo Almeida¹⁹, Carolina Benjamin²⁰, Douglas Kondziolka⁵, Jason P Sheehan⁴, Ajay Niranjan², Constantinos G Hadjipanayis², L Dade Lunsford²

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. aboualshaarh@upmc.edu.
² Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Division of Endocrinology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Neurosurgery, NYU Langone Medical Center, New York University, New York, USA.
⁶ Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, USA.
⁷ Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel.
⁸ Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
⁹ Department of Neurosurgery, PGIMER, Chandigarh, India.
¹⁰ Radiation Oncology, The James Cancer Center, Ohio State University, Columbus, OH, USA.
¹¹ Gamma Knife Centre - Nasser Institute, Cairo, Egypt.
¹² Neurosurgery Department, Benha University, Qualyobia, Egypt.
¹³ Clinical Oncology Department - Ain shams University, Cairo, Egypt.
¹⁴ Radiation Oncology Department - National Cancer Institute, Cairo University, Cairo, Egypt.
¹⁵ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
¹⁶ Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
¹⁷ Department of Neurosurgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
¹⁸ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia, Czechia.
¹⁹ Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, Canada.
²⁰ Department of Neurosurgery, University of Miami Health System, Miami, FL, USA.

PMID: 40442537
DOI: 10.1007/s11102-025-01542-z

Multicenter Study

Outcomes of stereotactic radiosurgery for pituitary metastases: an international multi-institutional study

Hussam Abou-Al-Shaar et al. Pituitary. 2025.

. 2025 May 29;28(3):69.

doi: 10.1007/s11102-025-01542-z.

Authors

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. aboualshaarh@upmc.edu.
² Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Division of Endocrinology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Neurosurgery, NYU Langone Medical Center, New York University, New York, USA.
⁶ Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, USA.
⁷ Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel.
⁸ Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
⁹ Department of Neurosurgery, PGIMER, Chandigarh, India.
¹⁰ Radiation Oncology, The James Cancer Center, Ohio State University, Columbus, OH, USA.
¹¹ Gamma Knife Centre - Nasser Institute, Cairo, Egypt.
¹² Neurosurgery Department, Benha University, Qualyobia, Egypt.
¹³ Clinical Oncology Department - Ain shams University, Cairo, Egypt.
¹⁴ Radiation Oncology Department - National Cancer Institute, Cairo University, Cairo, Egypt.
¹⁵ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
¹⁶ Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
¹⁷ Department of Neurosurgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
¹⁸ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia, Czechia.
¹⁹ Stereotactic and Functional Neurosurgery, University of British Columbia, Vancouver, Canada.
²⁰ Department of Neurosurgery, University of Miami Health System, Miami, FL, USA.

PMID: 40442537
DOI: 10.1007/s11102-025-01542-z

Abstract

Background: Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort.

Methods: The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications.

Results: Among 63 patients included in the study (median tumor volume: 1.5 cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10 Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63).

Conclusion: SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.

Keywords: Metastases; Pituitary neoplasms, hormonal outcomes; Progression-Free survival; Stereotactic radiosurgery; Survival analysis; Vision.

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Conflict of interest statement

Declarations. Ethical approval: IRB approval and patient consent were obtained from each of the participating centers. Competing interests: PKF has served as a consultant for Crinetics, Chiesi, Camurus, Regeneron, Xeris and Quest and has received research support from Crinetics, Corcept, Sparrow and Quest. These disclosures are not related to the content of the study.

References

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Outcomes of stereotactic radiosurgery for pituitary metastases: an international multi-institutional study

Affiliations

Outcomes of stereotactic radiosurgery for pituitary metastases: an international multi-institutional study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous