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Efficacy and safety of external beam radiation therapy in non-functioning pituitary adenomas: a case–control, nested in a cohort study

Published online by Cambridge University Press:  28 May 2013

Guadalupe Vargas ,
Baldomero González ,
Victoria Mendoza ,
Gerardo Guinto ,
Blas López-Félix  and
Moisés Mercado
Guadalupe Vargas
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Baldomero González
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Victoria Mendoza
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Gerardo Guinto
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Blas López-Félix
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Moisés Mercado*
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
*
Correspondence to: Moisés Mercado, Aristóteles 68, Polanco 11560, México City, México. Tel and fax: +5255-52813029 or +5255-52813029. E-mail: [email protected] or [email protected]
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Abstract

Background and objectives

Recurrence is frequent in surgically treated non-functioning pituitary adenomas (NFPA). The use of radiation therapy (RT) to prevent recurrence has to be weighted against the potential side effects, particularly, hypopituitarism. Our objective was to evaluate the efficacy and safety of RT in postoperative patients with NFPA with adenoma remnant.

Patients and methods

The 3- and 5-year outcome of 51 patients with NFPA with a remnant after surgery that received RT (cases) was compared with that of 61 subjects who did not receive RT (controls). Cases and controls were matched for postoperative remnant size, cavernous sinus invasion, age and gender.

Results

Tumour volume decreased in the radiated group from a median of 1,601 mm3 to 816 mm3 after 5 years of follow-up (p = 0·01, 50% tumour volume reduction). In the non-radiated controls median tumour volume decreased at 3 years but increased again after 5 years (baseline 1,415 mm3, 5 years 1,204 mm3, p = 0·93). Recurrence rate was 4% for the radiated group and 29% for the controls (OR 0·10, 95% CI 0·01–0·04, p = 0·02). Although pituitary hormone deficiencies at baseline were more prevalent in the radiated group, after 5 years, both groups showed a significant worsening of pituitary function. No RT-related side effects were recorded.

Conclusion

Postoperative RT is effective in preventing tumour regrowth in NFPA patients with postoperative remnants. The fact that hypopituitarism is highly prevalent even in non-radiated patients should allow a more generalised use of this treatment modality.

Keywords

hypopituitarismnon-functioning pituitary adenomaradiation therapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 1 , March 2014 , pp. 87 - 92
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

*

Guadalupe Vargas and Baldomero González have equally contributed to this work.

References

1.Dekkers, O M, Pereira, A M, Romjin, J A. Treatment and follow up of clinically non-functioning pituitary adenomas. J Clin Endocrinol Metab 2008; 93: 3717–3726.CrossRefGoogle Scholar
2.Molitch, M E. Non-functioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin North Amer 2008; 37: 151–171.CrossRefGoogle Scholar
3.Jane, J A Jr, Laws, E R Jr. The management of non-functioning pituitary adenomas. Neurol India 2003; 51: 461–465.Google ScholarPubMed
4.Roelfsema, F, Biermasz, N R, Pereira, A M. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structure review and meta-analysis. Pituitary 2012; 15: 71–83.CrossRefGoogle ScholarPubMed
5.Chandler, W F, Barkan, A L. Treatment of pituitary tumors: a surgical perspective. Endocrinol Metab Clin North Amer 2008; 37: 51–66.CrossRefGoogle ScholarPubMed
6.Webb, K M, Laurent, J J, Oknokwo, D O, Lopes, M B, Vance, M L, Laws, E R Jr. Clinical characteristics of silent corticotroph adenomas and creation of an internet-accessible database to facilitate their multi-institutional study. Neurosurgery 2003; 53: 1076–1084.CrossRefGoogle Scholar
7.Ramírez, C, Cheng, S, Vargas, Get al. Expression of Ki-67, PTTG1, FGFR4 and SSTR 2, 3 and 5 in non-functioning pituitary adenomas: a high throughput TMA immunohistochemical study. J Clin Endocrinol Metab 2012; 97: 1745–1751.CrossRefGoogle Scholar
8.Boelaert, K, Gittoes, N J. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 2001; 144: 569–575.CrossRefGoogle ScholarPubMed
9.Erridge, S C, Conkay, D S, Stockton, Det al. Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol 2009; 93: 597–601.CrossRefGoogle ScholarPubMed
10.Loeffler, J S, Shih, H A. Radiation therapy in the management of pituitary adenomas. J Clin Endocrinol Metab 2011; 96: 1992–2003.CrossRefGoogle ScholarPubMed
11.Wilson, P J, De-Loyde, K J, Williams, J R, Smee, R I. A single centre's experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with lineal accelerator (Linac). J Clin Neurosci 2012; 19: 370–374.CrossRefGoogle Scholar
12.O'Sullivan, E P, Woods, C, Glynn, Net al. The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas. Clin Endocrinol 2009; 71: 709–714.CrossRefGoogle ScholarPubMed
13.Dekkers, O M, Pereira, A M, Roelfsema, Fet al. Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 2006; 91: 1796–1801.CrossRefGoogle ScholarPubMed
14.Ertekin, T, Acer, N, Turgut, A T, Aycan, K, Özcelik, Ö, Turgut, M. Comparison of three methods for the estimation of the pituitary gland volume using magnetic resonance imaging: a stereological study. Pituitary 2011; 14: 31–38.CrossRefGoogle ScholarPubMed
15.Al-Mefy, O, Kersh, J E, Routh, A, Smith, R R. The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 1990; 73: 502–512.CrossRefGoogle Scholar
16.Van den Bergh, A C, van den Berg, G, Schoorl, M Aet al. Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: beneficial effect on local control without additional negative impact on pituitary function and life expectancy. Int J Radiat Oncol Biol Phys 2007; 67: 863–869.CrossRefGoogle ScholarPubMed
17.Chang, E F, Zada, G, Kim, Get al. Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 2008; 108: 736–745.CrossRefGoogle ScholarPubMed
18.Tomlinson, J W, Holden, N, Hils, R Ket al. Association between premature mortality and hypopituitarism. West Midlands prospective hypopituitary study group. Lancet 2001; 357: 425–431.CrossRefGoogle Scholar
19.Barker, F G II, Klibanski, A, Swearingen, B. Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity and the effect of hospital and surgeon volume. J Clin Endocrinol Metab 2003; 88: 4709–4719.CrossRefGoogle ScholarPubMed
20.Minitti, G, Traish, D, Ashley, S, Gonsalvez, A, Brada, M. Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 2005; 90: 800–804.CrossRefGoogle Scholar
21.Sattler, M G A, van Beek, A P, Wolffenbuttel, B H Ret al. The incidence of second tumours and mortality in pituitary adenoma patients treated with postoperative radiotherapy versus surgery alone. Radiother Oncol 2012; 104: 125–130.CrossRefGoogle ScholarPubMed
22.Bülow, B, Hagmar, L, Mikoczy, Z, Nordström, C H, Erfurth, E M. Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol 1997; 46: 75–81.CrossRefGoogle ScholarPubMed
23.Bates, A S, Bullivant, B, Sheppard, M C, Stewart, P M. Life expectancy following surgery for pituitary tumours. Clin Endocrinol 1999; 50: 315–319.CrossRefGoogle ScholarPubMed
24.Erfurth, E M, Bulow, B, Nordström, C H, Mikoczy, Z, Hagmar, L, Strömberg, U. Double mortality rate in irradiated patients reoperated for regrowth of a macroadenoma of the pituitary gland. Eur J Endocrinol 2004; 150: 497–502.CrossRefGoogle ScholarPubMed
25.Ayuk, J, Clayton, R N, Holder, G, Sheppard, M C, Stewart, P M, Bates, A S. Growth hormone and pituitary radiotherapy but not insulin-like growth factor-1 concentrations predict excess mortality in patients with acromegaly. J Clin Endocrinol Metab 2004; 89: 1613–1617.CrossRefGoogle Scholar