Upfront Stereotactic Radiosurgery for Nonfunctioning Pituitary Neuroendocrine Tumors: An International, Multicenter Study.
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Dumot Chloe, Mantziaris Georgios, Dayawansa Sam, Peker Selcuk, Samanci Yavuz, Nabeel Ahmed M, Reda Wael A, Tawadros Sameh R, AbdelKarim Khaled, El-Shehaby Amr M N, Emad Reem M, Abdelsalam Ahmed Ragab, Liscak Roman, May Jaromir, Mashiach Elad, De Nigris Vasconcellos Fernando, Bernstein Kenneth, Kondziolka Douglas, Speckter Herwin, Mota Ruben, Brito Anderson, Bindal Shray Kumar, Niranjan Ajay, Lunsford L Dade, Benjamin Carolina Gesteira, Almeida Timoteo, Mao Jennifer, Mathieu David, Tourigny Jean-Nicolas, Tripathi Manjul, Palmer Joshua David, Matsui Jennifer, Crooks Joseph, Wegner Rodney E, Shepard Matthew J, Sheehan Jason P
Аннотация
METHODS: The study evaluated tumor control and complications after single-session SRS in a multicentric cohort of untreated NFPA.
RESULTS: In total, 132 patients (median age 51.2 [IQR: 27.1] years at SRS, median volume 2.1 [IQR: 2.9] cm 3 ) were included. The probability of tumor control was 100% (95% CI: 100-100), 98.1% (95% CI: 94.6-100), and 92.4 (95% CI: 81.6-100) at 3, 5, and 8 years after SRS. The cumulative probability of new pituitary deficit was 11.7% (95% CI: 3.8-18.9), 24.4% (95% CI: 12.1-35.1), and 29.5% (95% CI: 12.1-26.9) at 3, 5, and 8 years, respectively. No new visual field defect occurred. Before SRS, 50 patients (37.9%) presented with a visual field defect with a complete improvement in 17 (34.7%), partial improvement in 12 (24.5%), and stability in 19 (38.8%) at a last follow-up of 2.2 (3.9) years. One patient (2.0%) worsened after SRS. Before SRS, 10 patients (7.6%) presented with an oculomotor nerve palsy. One patient (0.8%) developed a new transient nerve palsy. At a last follow-up of 2.5 (4.4) years, 5 patients (45.4 35.7%) had a stability of their palsy, 1 had a partial improvement (9.1%), and 5 (45.4%) had a complete improvement.
CONCLUSION: Upfront SRS represents an option for appropriately selected patients with NFPA, and it exhibits a favorable efficacy and safety profile, but a longer follow-up is required. Visual improvement is low, and careful selection of patient is required.