Outcome of Nonfunctioning Pituitary Adenomas That Regrow After Primary Treatment: A Study From Two Large UK Centers

Tampourlou, Metaxia; Ntali, Georgia; Ahmed, Shahzada; Arlt, Wiebke; Ayuk, John; Byrne, James; Chavda, Swarupsinh; Cudlip, Simon; Gittoes, Neil; Grossman, Ashley; Mitchell, Rosalind; O’Reilly, Michael; Paluzzi, Alessandro; Toogood, Andrew; Wass, John; Karavitaki, Niki

doi:10.1210/jc.2016-4061

Cited by 77 publications

(58 citation statements)

References 26 publications

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“…Similarly to our case, aggressive pituitary tumours usually respond badly to standard medical treatments. The first-line treatment of aggressive pituitary tumours is neurosurgery; however, in about 35% of patients we observe regrowth with median follow-up of regrowth by 5.9 years [11].…”

Section: Discussionmentioning

confidence: 72%

Temozolomide therapy for aggressive pituitary Crooke’s cells corticotropinoma causing Cushing’s Disease: A case report with literature review

Gilis‐Januszewska

Wilusz

Pantofliński

et al. 2015

Endokrynologia Polska

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The case of our patient suggests that the response to the TMZ treatment monotherapy in aggressive pituitary tumour causing Cushing's Disease could be partial and restricted to 7-8 cycles followed by rapid progression of the tumor mass. Therefore, further research should be carried out with regard to new methods to extend the responsiveness and duration of TMZ treatment and to investigate predictors of responsiveness. < p > < /p >.

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Section: Discussionmentioning

confidence: 72%

Temozolomide therapy for aggressive pituitary Crooke’s cells corticotropinoma causing Cushing’s Disease: A case report with literature review

Gilis‐Januszewska

Wilusz

Pantofliński

et al. 2015

Endokrynologia Polska

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“…However, this therapy is limited to residual tumour, which is distant from optic pathways, and the poor results from standard radiation therapy are surprising. In a large and more recent series, recurrent NFPAs which subsequently received standard external beam radiotherapy showed a lower recurrence rate than those observed or who were treated by surgery alone, so it may be that the efficacy of radiotherapy is contingent on the centre as much as on the specific type (Tampourlou et al 2017).…”

Section: Endocrine-related Cancermentioning

confidence: 93%

Aggressive and malignant pituitary tumours: state-of-the-art

Dworakowska¹,

Grossman²

2018

Endocrine-Related Cancer

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Pituitary adenomas are unique in multiple ways. They are rarely malignant in terms of metastases, yet they may be aggressive. Their cancerous potential is defined in a classic oncological way by the ability to metastasise, and therefore it has been crucial to differentiate this process from aggressive behaviour, characterised as a particularly invasive and/or recurrent behaviour and resistance to common modalities of therapy. Recently, however, important changes have been introduced to the diagnosis and management of aggressive and malignant pituitary tumours including the 4th edition of the WHO classification for endocrine tumours (2017) as well as ESE Clinical Guidelines (2018), although an attempt to establish predictive and/or prognostic markers of clinical aggressiveness remains difficult. In this review, we focus on a group of pituitary tumours causing significant problems in clinical practice and requiring multidisciplinary input. We summarise updates in definitions of tumour invasiveness, aggressiveness and malignant transformation, as well as histological classification, and emphasise the new considerations regarding aggressive and malignant potential and its relationship to therapeutic strategies.

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“…R 2.1. 4 In patients with aggressive pituitary tumours, and either site-specific symptoms or discordant biochemical and radiological findings, we recommend screening for metastatic disease.…”

Section: Diagnosis Of An Aggressive Pituitary Tumourmentioning

confidence: 99%

“…R 3.4. 4 We recommend monitoring of haematological parameters, liver function tests and careful clinical observation for potential adverse effects during treatment (+++0). R 3.4.…”

Section: Medical Therapies In Aggressive Pituitary Tumoursmentioning

confidence: 99%

“…The clinical behaviour of pituitary tumours is highly variable: some remain quiescent for long periods of time; many grow slowly, while in rare cases rapid tumour growth is observed. Post-operatively, about 30% of the patients show tumour regrowth 0.4-37 years after surgery, with an increased risk of tumour progression in the presence of residual tumour (4). A small subset of pituitary tumours has been classified as aggressive pituitary tumours, based on resistance to medical treatment and multiple recurrences despite standard therapies combining surgical, medical and radiotherapy treatment approaches.…”

Section: Introductionmentioning

confidence: 99%

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European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

482

583

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Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.

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Outcome of Nonfunctioning Pituitary Adenomas That Regrow After Primary Treatment: A Study From Two Large UK Centers

Cited by 77 publications

References 26 publications

Temozolomide therapy for aggressive pituitary Crooke’s cells corticotropinoma causing Cushing’s Disease: A case report with literature review

Temozolomide therapy for aggressive pituitary Crooke’s cells corticotropinoma causing Cushing’s Disease: A case report with literature review

Aggressive and malignant pituitary tumours: state-of-the-art

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

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