Early adjuvant radiation reduces the rate of recurrence following surgery for silent corticotroph pituitary neuroendocrine tumors.

PURPOSE: Silent corticotroph tumors (SCTs) are rare, clinically and biochemically silent tumors of the T-pit lineage. They have been demonstrated to exhibit aggressive clinical behavior, with frequent preoperative invasion of the cavernous sinus and sphenoid sinus, and greater postoperative recurrence. We therefore aimed to examine the impact of early adjuvant radiation (EAR) on the rate of recurrence.

METHODS

We assimilated data from all patients operated on for SCTs between 2013 and 2023 at our center, examining their clinicoradiological profiles, details of surgery, surgical complications and the rate of recurrence following surgery. We assessed the impact of EAR, defined as radiation administered to residual tumor detected on postoperative imaging prior to recurrence on the progression-free survival.

RESULTS

The cohort comprised 57 patients, 24 males (42.1 %) and 33 females (57.9 %). Twenty-one tumors were giant PitNETs (36.8 %) while 36 (63.2 %) were macroadenomas. A gross total resection (GTR) was affected in 21 cases (36.8 %), with the remaining deemed subtotal resection (36 cases, 63.2 %). There was one mortality in the immediate postoperative period. Twenty-one of 36 patients (58.3 %) received EAR- seven patients underwent gamma knife radiosurgery, while 14 patients underwent conventional radiation therapy. Recurrence occurred in 14 of 56 cases (25 %), after a median time of 17 months. When the groups were stratified by the extent of resection, we noted significantly more frequent use of EAR among the non-recurrent SCTs (p = 0.004). Multivariate analysis revealed that only the absence of EAR was significantly associated with the recurrence of SCTs.

CONCLUSIONS

Silent corticotroph tumors are aggressive PitNETs that recur in 25 % of cases. Early adjuvant radiation is protective against recurrence when a GTR cannot be performed, significantly improving progression-free survival.