Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas

Chang, Edward F.; Zada, Gabriel; Kim, Sang; Lamborn, Kathleen R.; Quiñones‐Hinojosa, Alfredo; Tyrrell, James; Wilson, Charles B.; Kunwar, Sandeep

doi:10.3171/jns/2008/108/4/0736

Cited by 155 publications

(136 citation statements)

References 38 publications

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“…Gross total removal is the most important prognostic factor to avoid recurrence in patients with pituitary adenomas with Ki-67 labeling index of more than 3%. 3,19,22) Therefore, complete resection remains an essential factor.…”

Section: Discussionmentioning

confidence: 99%

“…1,12,33) Several studies suggest that high Ki-67 values predict more aggressive behavior, [1][2][3]8,9,12,20,21) but no firm consensus has been reached regarding a precise cutoff value. The present study investigated the use of MIB-1 proliferating cell index to predict re-growth of residual pituitary adenomas after surgery and the correlations between various clinical variables and MIB-1 index in patients with pituitary adenomas with and without rapid re-growth after initial surgery.…”

mentioning

confidence: 99%

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Ki-67 Expression for Predicting Progression of Postoperative Residual Pituitary Adenomas: Correlations With Clinical Variables

Matsuyama

2012

Neurol. Med. Chir.(Tokyo)

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Reliable prognostic parameters indicating progression in residual pituitary adenoma after surgery are necessary. The World Health Organization classification of tumors of endocrine organs defines atypical pituitary adenomas as tumor with Ki-67 labeling index higher than 3%, excessive p53 immunoreactivity, and increased pleomorphism. The real value of Ki-67 labeling index correlating with tumor progression is controversial. We investigated the relationship between positive labeling for MIB-1 and clinical features of 39 patients with pituitary adenomas with and without rapid re-growth after initial surgery. Ki-67 expression revealed pituitary adenomas with progression (re-growth within 5 years after initial surgery) had a mean proliferation index of 3.66 ± 3.00% (mean ± standard deviation [SD], n ＝ 12), which was significantly higher than in tumors without progression of 1.89 ± 1.25% (mean ± SD, n ＝ 27) (p º 0.05, Mann-Whitney test). Receiver operating characteristic analysis showed a threshold level of Ki-67 expression greater than 2.0% predicts progression with high specificity. Younger patients had higher MIB-1 index and more progression (p º 0.05). Adenomas with cavernous sinus invasion, functioning adenomas, and giant adenomas had higher MIB-1 index (p º 0.05). There was no significant correlation between tumor size or cavernous sinus invasion and progression. More completely removed tumors were less progressive. A threshold of 2% for the MIB-1 labeling index predicts higher risk of progression of residual adenomas after surgery, so shorter interval of follow-up neuroimaging, and early initiation of adjuvant therapy might be required.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ki-67 Expression for Predicting Progression of Postoperative Residual Pituitary Adenomas: Correlations With Clinical Variables

Matsuyama

2012

Neurol. Med. Chir.(Tokyo)

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“…[1][2][3] Incidental pituitary tumors are found in approximately 10% of patients undergoing neuroimaging for other reasons. 4 These tumors are classified as microadenomas (≤1 cm diameter) and macroadenomas (>1 cm diameter) according to their size, and also classified as functioning and nonfunctioning tumors according to their functional hormone secreting status.…”

Section: Introductionmentioning

confidence: 99%

“…SRS may also be utilized in unresectable patients. Chang et al 3 compared surgery only with surgery and radiotherapy combination in a series of 663 patiets with non-functioning pituitary adenomas. They found the most important factor associated with long-term cure to be gross total resection, and that adjuvant radiotherapy decreased recurrence rates in patients with subtotal excision.…”

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confidence: 99%

Stereotactic Radiosurgery in Pituitary Adenomas: A Single Center Experience

Surenkok¹

2012

UHOD

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The aim of this study was to evaluate the efficiency of stereotactic radiosurgery (SRS) in the management of pituitary adenomas. Between June 1998 and July 2011, 57 patients with pituitary adenomas were treated using SRS at our department. All patients underwent high-precision single dose SRS using a linear accelerator with 6-MV photons. Median follow-up time was 31.5 (3-92) months. Median age was 40 years (range: 19-57 years). Radiological tumor growth control was achieved in 48 patients (84.2%) (a decrease in tumor size in 25 patients and no change in tumor size in 23 patients). 13 patients with functioning adenomas had available biochemical follow-up and biochemical complete response was achieved in 8 (61.5%) of these 13 patients. Treatment of pituitary adenomas using LINAC-based single dose SRS is safe and effective in improving local tumor and biochemical control. Keywords: Pituitary adenoma, Stereotactic radiosurgery, Growth hormone ÖZET Hipofiz Adenomlar›nda Stereotaktik Radyocerrahi: Tek Merkez DeneyimiBu çal›flman›n amac› stereotaktik radyocerrahi'nin hipofiz adenomu manajman›ndaki etkinli¤inin de¤erlendirilmesidir. Klini¤i-mizde Haziran 1998 ile Temmuz 2011 tarihleri aras›nda hipofiz adenomlu 57 hasta stereotaktik radyocerrahi ile tedavi edilmifltir. Tüm hastalara lineer akseleratörde 6 MV fotonlarla tek dozda yüksek hassasiyetli stereotaktik radyocerrahi uygulanm›flt›r. Medyan takip süresi 31.5 ay (s›n›rlar: 3-92 ay) idi. Radyolojik tümör büyüme kontrolü 48 hastada (84.2%) sa¤lanm›fl-t›r (25 hastada tümör boyutunda küçülme, 23 hastada tümör boyutunda de¤ifliklik yok). Biyokimyasal takibi mevcut olan fonksiyone adenomlu 13 hastadan 8'inde (%61.5) biyokimyasal tam cevap elde edilmifltir. Linak tabanl› tek doz stereotaktik radyocerrahi ile hipofiz adenomlar›n›n tedavisi lokal tümör kontrolü ve biyokimyasal kontrolün iyilefltirmesinde güven-li ve etkindir.

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“…Surgery is the first-line treatment for NFPAs, but approximately 40% of them have invasion of bone, dura, and/or adjacent structures. These invasive NFPAs are difficult to resect completely and the patients often develop tumor recurrence quickly after initial surgery [3]. Thus, further pharmacotherapy is required to control symptoms.…”

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confidence: 99%

Folate receptor-mediated boron-10 containing carbon nanoparticles as potential delivery vehicles for boron neutron capture therapy of nonfunctional pituitary adenomas

Dai

Cai

Hwang

et al. 2013

Sci. China Life Sci.

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Invasive nonfunctional pituitary adenomas (NFPAs) are difficult to completely resect and often develop tumor recurrence after initial surgery. Currently, no medications are clinically effective in the control of NFPA. Although radiation therapy and radiosurgery are useful to prevent tumor regrowth, they are frequently withheld because of severe complications. Boron neutron capture therapy (BNCT) is a binary radiotherapy that selectively and maximally damages tumor cells without harming the surrounding normal tissue. Folate receptor (FR)-targeted boron-10 containing carbon nanoparticles is a novel boron delivery agent that can be selectively taken up by FR-expressing cells via FR-mediated endocytosis. In this study, FR-targeted boron-10 containing carbon nanoparticles were selectively taken up by NFPAs cells expressing FR but not other types of non-FR expressing pituitary adenomas. After incubation with boron-10 containing carbon nanoparticles and following irradiation with thermal neutrons, the cell viability of NFPAs was significantly decreased, while apoptotic cells were simultaneously increased. However, cells administered the same dose of FR-targeted boron-10 containing carbon nanoparticles without neutron irradiation or received the same neutron irradiation alone did not show significant decrease in cell viability or increase in apoptotic cells. The expression of Bcl-2 was down-regulated and the expression of Bax was up-regulated in NFPAs after treatment with FR-mediated BNCT. In conclusion, FR-targeted boron-10 containing carbon nanoparticles may be an ideal delivery system of boron to NFPAs cells for BNCT. Furthermore, our study also provides a novel insight into therapeutic strategies for invasive NFPA refractory to conventional therapy, while exploring these new applications of BNCT for tumors, especially benign tumors.

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Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas

Cited by 155 publications

References 38 publications

Ki-67 Expression for Predicting Progression of Postoperative Residual Pituitary Adenomas: Correlations With Clinical Variables

Ki-67 Expression for Predicting Progression of Postoperative Residual Pituitary Adenomas: Correlations With Clinical Variables

Stereotactic Radiosurgery in Pituitary Adenomas: A Single Center Experience

Folate receptor-mediated boron-10 containing carbon nanoparticles as potential delivery vehicles for boron neutron capture therapy of nonfunctional pituitary adenomas

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