Long‐term follow‐up of a large prospective cohort of patients with nonfunctioning pituitary adenomas: The outcome of a conservative management policy

Levy, Miles; Robertson, Iain; Khalk, Naima; Vitello, Sabrina; Reddy, Narendra; Bhake, Ragini; Howlett, Trevor A.

doi:10.1111/cen.13791

Cited by 24 publications

(16 citation statements)

References 14 publications

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“…Follow-up showed a low rate of recurrence in our NFPA series, in accordance with the majority of reported studies [11,29,30], though not all [31][32][33][34], with or without radiotherapy. A meta-analysis reported a 2-fold higher risk of recurrence without radiotherapy compared to radiotherapy of NFPA [32].…”

Section: Discussionsupporting

confidence: 92%

“…A meta-analysis reported a 2-fold higher risk of recurrence without radiotherapy compared to radiotherapy of NFPA [32]. A long term follow-up survey of 190 cases of NFPA has reported a 25 % recurrence rate at 10 years, in those with no residual tumor after pituitary surgery, increasing to a 60 % recurrence rate in the case of post-surgical intrasellar residuum [33]. Recently, Lelotte et al reported a series of 120 NFPA macroadenomas retrospectively evaluated for clinical outcomes and found 5-year recurrence of between 20 and 66 % depending on their initial proliferative and invasive status [34].…”

Section: Discussionmentioning

confidence: 99%

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Quality of Life but not Cognition is Impacted by Radiotherapy in Patients with Non-Functioning Pituitary Adenoma

et al. 2019

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Non-functioning pituitary adenomas (NFPA) are benign neoplasms that are first treated by surgery and secondary radiation therapy in case of residual tumor or regrowth. The consequences of surgery and radiotherapy are still debated. The objective of the work was to assess the impact of surgery, radiotherapy (RT) and pituitary deficiencies on long term health-related quality of life (QoL) and cognitive function among NFPA patients. Forty-six NFPA patients were studied after 9.6±7.5 years follow-up using: i) the MoCA questionnaire to detect mild cognitive disabilities, ii) the McNair and Kahn scale to assess perceived cognitive impairment, iii) the HADS questionnaire to score anxiety and depression, and iv) the SF-36 and QLS-H questionnaires to assess QoL. All NFPA patients had surgery and 54% patients had radiation therapy (RT+). The MoCA score was abnormal in 41% NFPA patients. Neither the type of surgery nor radiotherapy influenced the prevalence of cognitive disabilities. The depression score was higher in RT+than RT– patients. Overall, no alteration in SF-36 and QLS-H QoL scales were observed in NFPA patients when compared with the French reference population. Among NFPA patients, mental composite score, general health and vitality scores were altered in RT+compared to RT– patients. The presence of multiple pituitary axis deficiencies worsened general health and vitality scale scoring. Consistent follow-up had a beneficial impact on psycho-emotional dimensions of health. Surgery and radiotherapy had no adverse effects on cognitive functions, however, QoL was altered in RT+patients. These latter alterations may be partly related to pituitary hormone deficiencies.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Quality of Life but not Cognition is Impacted by Radiotherapy in Patients with Non-Functioning Pituitary Adenoma

et al. 2019

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“…2,4 Longterm outcomes following EES for pituitary adenomas have shown recurrence rates up to 10.7%-25.0% (Table 9). 3,22,37 Dallapiazza et al and Levy et al reported rates of 20% and 25%, respectively, according to the 10-year Kaplan-Meier estimate. Our study, which established extent of resection with postoperative MRI, revealed a much lower 10-year recurrence rate of 4.7%.…”

Section: Fig 3 Predictors Of Recurrence/progression-free Survival In the Entire Cohort (A-c) And Predictors Of Progression-free Survival mentioning

confidence: 97%

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Gerges

Rumalla

Godil

et al. 2021

Journal of Neurosurgery

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OBJECTIVENonfunctioning pituitary adenomas are benign, slow-growing tumors. After gross-total resection (GTR) or subtotal resection (STR), tumors can recur or progress and may ultimately require additional intervention. A greater understanding of long-term recurrence and progression rates following complete or partial resection and the need for further intervention will help clinicians provide meaningful counsel for their patients and assist data-driven decision-making.METHODSThe authors retrospectively analyzed their institutional database for patients undergoing endoscopic endonasal surgery (EES) for nonfunctioning pituitary macroadenomas (2003–2014). Only patients with follow-up of at least 5 years after surgery were included. Tumor volumes were measured on pre- and postoperative MRI. Tumor recurrence was defined as the presence of a 0.1-cm3 tumor volume after GTR, and tumor progression was defined as a 25.0% increase in residual tumor after STR.RESULTSA total of 190 patients were included, with a mean age of 63.8 ± 13.2 years; 79 (41.6%) were female. The mean follow-up was 75.0 ± 18.0 months. GTR was achieved in 127 (66.8%) patients. In multivariate analysis, age (p = 0.04), preoperative tumor volume (p = 0.03), Knosp score (p < 0.001), and Ki-67 (p = 0.03) were significant predictors of STR. In patients with GTR, the probability of recurrence at 5 and 10 years was 3.9% and 4.7%, and the probability of requiring treatment for recurrence was 0.79% and 1.6%, respectively. In 63 patients who underwent STR, 6 (9.5%) received early postoperative radiation and did not experience progression, while the remaining 57 (90.5%) were observed. Of these, the probability of disease progression at 5 and 10 years was 21% and 24.5%, respectively, and the probability of requiring additional treatment for progression was 17.5% and 21%. Predictors of recurrence or progression in the entire group were Knosp score (p < 0.001) and elevated Ki-67 (p = 0.03). Significant predictors of progression after STR in those who did not receive early radiotherapy were cavernous sinus location (p < 0.05) and tumor size > 1.0 cm3 (p = 0.005).CONCLUSIONSFollowing GTR for nonfunctioning pituitary adenomas, the 10-year chance of recurrence is low and the need for treatment even lower. After STR, although upfront radiation therapy may prevent progression, even without radiotherapy, the need for intervention at 10 years is only approximately 20% and a period of observation may be warranted to prevent unnecessary prophylactic radiation therapy. Tumor volume > 1 cm3, Knosp score ≥ 3, and Ki-67 ≥ 3% may be useful metrics to prompt closer follow-up or justify early prophylactic radiation therapy.

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“…Arising from adenohypophyseal cells, these masses present either incidentally on imaging or via symptoms secondary to cranial mass such as headache, pituitary dysfunction, or visual disturbances. Therapy in way of hormonal replacement and/or surgical management via transsphenoidal approach is directed at correcting hypopituitarism or eliminating mass effect on adjacent neural structures, respectively [27]. Despite the availability of therapeutic modalities to treat NFPAs, the genetic mechanisms that lead to the initiation of NFPAs remain incompletely understood, particularly as pertaining to SNPs.…”

Section: Snps In Nonfunctional Pituitary Adenomasmentioning

confidence: 99%

The Role of Single-Nucleotide Polymorphisms in Pituitary Adenomas Tumorigenesis

Shah

Aghi

2019

Cancers

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Pituitary adenomas (PAs) are among the most common intracranial neoplasms, but despite their histologically benign nature, these tumors sometimes grow large enough to cause symptoms of mass effect such as vision loss, headaches, or hypopituitarism. When they get this large, surgery will unfortunately not be curative and, other than prolactinomas, medical options are limited, and radiation has variable efficacy in controlling growth. Understanding the genetic perturbations, such as single nucleotide polymorphisms (SNPs), that promote the formation or growth of functional and nonfunctional PAs is important because such genetic insights could improve the diagnosis and subsequent classification of PAs as well as unlock potential therapeutic targets outside contemporary standard of care. While there have been great strides in the research of SNPs as drivers of PA formation and maintenance, a comprehensive discussion of these genetic mutations has not been undertaken. In the present article, and with the goal of providing scientists and clinicians a central review, we sought to summarize the current literature on SNPs and their relationship to PA formation. Across multiple tumor types, such as nonfunctioning PAs, prolactinomas, corticotroph adenomas, somatotroph adenomas, thyrotropic adenomas, and gonadotroph adenomas, SNPs in cell surface receptors implicated in proliferation can be appreciated. Polymorphisms found in tumor suppressors and cell cycle regulators have also been identified, such as p53 SNPs in nonfunctioning PAs or cyclin D1 in prolactinomas. While the translational relevance of SNPs in the formation of PAs is still in the early stages, the use of wide-scale genomic analysis to identify patients at risk for developing PAs could yield therapeutic benefit in the future.

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Long‐term follow‐up of a large prospective cohort of patients with nonfunctioning pituitary adenomas: The outcome of a conservative management policy

Abstract: This study suggests that a conservative approach may be safe and appropriate in patients with NFPA if followed up with appropriate imaging surveillance, whether postoperative or without primary surgery.

Cited by 24 publications

References 14 publications

Quality of Life but not Cognition is Impacted by Radiotherapy in Patients with Non-Functioning Pituitary Adenoma

Quality of Life but not Cognition is Impacted by Radiotherapy in Patients with Non-Functioning Pituitary Adenoma

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

The Role of Single-Nucleotide Polymorphisms in Pituitary Adenomas Tumorigenesis

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