Deferred radiotherapy after debulking of non-functioning pituitary macroadenomas: Clinical outcomes

Sarah E. Nicholas, Roberto Salvatori, Alfredo Quinones-Hinojosa, Kristin Redmond, Gary Gallia, Michael Lim, Daniele Rigamonti, Henry Brem, Lawrence Kleinberg

Research output: Contribution to journalArticle

Abstract

Background: To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression. Methods: Two hundred and sixty-seven patients were treated surgically for pituitary tumors at our institution between 1997 and 2005. One hundred and twenty-six patients met the inclusion criteria of NFPMA. They were followed for at least 2 years. Results: At presentation, 58% of patients had objectively decreased visual function, 66% had endocrine abnormalities, and 46% had headaches. Of the entire cohort, 75% of tumors abutted the optic chiasm and 87% had suprasellar extension. Over a median follow up of 112 months from surgery, 52% of patients had evidence of radiographic tumor progression, and 39% required additional treatment. There was a significant difference freedom from progression and in the number of patients receiving additional treatment with preoperative adenoma size of < 2 vs. ≥2 cm (p < 0.05). Conclusion: Close observation with radiation therapy delayed until the time of progression is an appropriate option for patients presenting with initial adenoma size < 2 cm, and can be considered for those with initial sizes up to 4 cm, as the majority of patients do not require further intervention for 10 or more years, thereby meaningfully postponing the risks of radiotherapy.

Original languageEnglish (US)
Article number660
JournalFrontiers in Oncology
Volume9
Issue numberJAN
DOIs
StatePublished - Jan 1 2019

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Radiotherapy
Adenoma
Optic Chiasm
Pituitary Neoplasms
Headache
Neoplasms
Observation
Therapeutics

Keywords

  • Macroadenoma
  • Non-functioning
  • Outcomes
  • Pituitary
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Deferred radiotherapy after debulking of non-functioning pituitary macroadenomas : Clinical outcomes. / Nicholas, Sarah E.; Salvatori, Roberto; Quinones-Hinojosa, Alfredo; Redmond, Kristin; Gallia, Gary; Lim, Michael; Rigamonti, Daniele; Brem, Henry; Kleinberg, Lawrence.

In: Frontiers in Oncology, Vol. 9, No. JAN, 660, 01.01.2019.

Research output: Contribution to journalArticle

Nicholas, SE, Salvatori, R, Quinones-Hinojosa, A, Redmond, K, Gallia, G, Lim, M, Rigamonti, D, Brem, H & Kleinberg, L 2019, 'Deferred radiotherapy after debulking of non-functioning pituitary macroadenomas: Clinical outcomes', Frontiers in Oncology, vol. 9, no. JAN, 660. https://doi.org/10.3389/fonc.2018.00660
Nicholas, Sarah E. ; Salvatori, Roberto ; Quinones-Hinojosa, Alfredo ; Redmond, Kristin ; Gallia, Gary ; Lim, Michael ; Rigamonti, Daniele ; Brem, Henry ; Kleinberg, Lawrence. / Deferred radiotherapy after debulking of non-functioning pituitary macroadenomas : Clinical outcomes. In: Frontiers in Oncology. 2019 ; Vol. 9, No. JAN.
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