This month the PNA Medical Corner spotlights an article co-authored by Dr. James J. Evans of Thomas Jefferson University, a member of the PNA. The study finds that observation of nonfunctioning pituitary tumors with FSRT can delay the onset of hypopituitarism while maintaining similar effectiveness in tumor control”.
Early versus Delayed Fractionated Stereotactic Radiotherapy for Nonfunctioning Pituitary Adenoma
- PMID: 37757941 DOI: 10.1016/j.wneu.2023.09.067
Abstract
Background: Fractionated stereotactic radiotherapy (FSRT) is a common modality used to treat pituitary adenomas with good control rates. It is currently unknown whether FSRT should be performed early or delayed until progression occurs
Objective: We compared FSRT in treating non-functional pituitary adenomas (NFPA) as an adjuvant (ADJ) or on-progression (PRG) therapy
Methods: A retrospective review of patients who underwent FSRT for a NFPA between January 2004 to December 2022 at a single institution was performed. We compared endocrinologic, ophthalmologic, and radiographic outcomes in FSRT delivered as ADJ and PRG treatment.
Results: 75 patients were analyzed, with a median follow-up of 53 months. FSRT was administered to 35 and 40 patients as ADJ and PRG, with a median time-to-treatment of 5.5 and 40 months, respectively. The tumor control rate was 94.3% for ADJ and 95.0% for PRG. Treatment resulted in four (11.4%) versus seven (17.5%) new endocrinopathies and two (5.7%) versus one (2.5%) new visual deficits for ADJ versus PRG. A survival analysis of time-to-new endocrinopathy showed no difference between the two cohorts. Median time from surgery to new endocrinopathy was significantly different between ADJ and PRG, at 15.5 and 102.0 months, respectively.
Conclusion: FSRT is effective in treating NFPA for residual and progressive tumors, with excellent tumor control rates and a low risk of developing new endocrinopathies and visual deficits. Delaying treatment delayed development of new endocrinopathies, suggesting that observation with FSRT on tumor progression may delay the onset of hypopituitarism while maintaining similar effectiveness in tumor control.
Keywords: FSRT; Fractionation; Pituitary adenoma; Recurrent; Residual; radiotherapy.
Copyright © 2023. Published by Elsevier Inc.
