A Rapid Biochemical and Radiological Response to the Concomitant Therapy with Temozolomide and Radiotherapy in an Aggressive ACTH Pituitary Adenoma

Background and Importance. In the last eight years temozolomide (TMZ) has been used as the last-line treatment modality for aggressive pituitary tumors to be applied after the failure of surgery, medical therapy, and radiotherapy. The objective was to achieve a rapid control of tumor growth and hormone normalization with concurrent chemoradiotherapy in a patient with very aggressive ACTH pituitary adenoma. Clinical Presentation. We describe a patient with an aggressive ACTH-producing adenoma treated with concurrent temozolomide and radiotherapy. The patient suffered from an aggressive ACTH adenoma resistant to surgical and medical treatment. After two months of concurrent temozolomide and radiotherapy, cortisol normalization and significant tumor shrinkage were observed. After 22 months of follow-up, there is still no evidence of tumor recurrence. Conclusion. Concurrent treatment with temozolomide and irradiation appears to be highly effective in the achievement of the tumor volume control as well as in the control of ACTH secretion in aggressive ACTH adenoma.

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The Effectiveness of Diffusion Tensor Imaging in Determining Radiological Response after Radiosurgery in Patients with Vestibular Schwannoma

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210127160848 ◽

2021 ◽

Vol 17 ◽

Author(s):

Dilek Hacer Cesme ◽

Alpay Alkan ◽

Lutfullah Sari ◽

Ahmet Kaya ◽

Ismail Yurtsever ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Vestibular Schwannoma ◽

Tumor Volume ◽

Diffusion Tensor ◽

Response To Treatment ◽

Adc Values ◽

Radiological Response ◽

Group 2 ◽

Group 1

Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Results: The mean duration of follow-up was 28.81±14 months. ADC values increased in patients with VS after radiosurgery (p=0.004). There was no statistical difference in the FA values. A significant reduction in TTV after radiosurgery was detected in group 1 (p=0.003). ADC values increased significantly after radiosurgery in group 2 (p=0.04). Although there were no significant differences, ADC values after radiosurgery increased in group 1 and group 0. Conclusions: ADC values continuously increase due to radiation damage in the period before the tumor volume shrinks after radiosurgery. We think that it is not appropriate to diagnose inadequate treatment or progression only when TTV is evaluated in terms of response to treatment in the early period after radiosurgery.

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Radiosurgical Management of Benign Cavernous Sinus Tumors: Dose Profiles and Acute Complications

Neurosurgery ◽

10.1097/00006123-200105000-00011 ◽

2001 ◽

Vol 48 (5) ◽

pp. 1022-1032 ◽

Cited By ~ 33

Author(s):

Joseph C.T. Chen ◽

Steven L. Giannotta ◽

Cheng Yu ◽

Zbigniew Petrovich ◽

Michael L. Levy ◽

...

Keyword(s):

Surgical Treatment ◽

Pituitary Adenoma ◽

Radiation Dose ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Tumor Volume ◽

Grade Iii

Abstract OBJECTIVE Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife. METHODS From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions. The tumor type distribution was 29 pituitary adenomas, 35 meningiomas, 4 schwannomas, and 1 paraganglioma. The median follow-up was 122 weeks. Lesions were stratified according to a five-level surgical grade. The grade distribution of the tumors was as follows: Grade I, 13; Grade II, 21; Grade III, 19; Grade IV, 12; Grade V, 4. Median tumor volume was 4.7 cm3. The median radiation dose was 15 Gy to the 50% isodose line. Median maximal radiation dose was 30 Gy. RESULTS Analysis of tumor characteristics and radiation dose to optic nerve and pontine structures revealed a significant correlation between distance and dose. Much lower correlation coefficients were found between tumor volume and dose. One lesion in this series had evidence of transient progression and later regression on follow-up radiographic studies. No other lesions in this series were demonstrated to have exhibited progression. Complications after radiosurgical treatment were uncommon. Two patients had cranial nerve deficits after treatment. One patient with a surgical Grade III pituitary adenoma had VIth cranial nerve palsy 25 months after radiosurgical treatment that spontaneously resolved 10 months later. A patient with a bilateral pituitary adenoma experienced bilateral VIth cranial nerve palsy 3 months after treatment that had not resolved at 35 months after treatment. Six patients with preoperative cranial nerve deficits experienced resolution or improvement of their deficits after treatment. One patient with a prolactin-secreting adenoma experienced normalization of endocrine function with return of menses. CONCLUSION Radiosurgical treatment represents an important advance in the management of cavernous sinus tumors, with low risk of neurological deficit in comparison with open surgical treatment, even in patients with high surgical grades.

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Stereotactic radiosurgery in the treatment of parasellar meningiomas: long-term volumetric evaluation

Journal of Neurosurgery ◽

10.3171/2016.11.jns161402 ◽

2018 ◽

Vol 128 (2) ◽

pp. 362-372 ◽

Cited By ~ 11

Author(s):

Or Cohen-Inbar ◽

Athreya Tata ◽

Shayan Moosa ◽

Cheng-chia Lee ◽

Jason P. Sheehan

Keyword(s):

Tumor Volume ◽

Survival Rates ◽

Progression Free Survival ◽

Volume Control ◽

Tumor Control ◽

Who Grade ◽

Free Survival ◽

Nerve Dysfunction

OBJECTIVEParasellar meningiomas tend to invade the suprasellar, cavernous sinus, and petroclival regions, encroaching on adjacent neurovascular structures. As such, they prove difficult to safely and completely resect. Stereotactic radiosurgery (SRS) has played a central role in the treatment of parasellar meningiomas. Evaluation of tumor control rates at this location using simplified single-dimension measurements may prove misleading. The authors report the influence of SRS treatment parameters and the timing and volumetric changes of benign WHO Grade I parasellar meningiomas after SRS on long-term outcome.METHODSPatients with WHO Grade I parasellar meningiomas treated with single-session SRS and a minimum of 6 months of follow-up were selected. A total of 189 patients (22.2% males, n = 42) form the cohort. The median patient age was 54 years (range 19–88 years). SRS was performed as a primary upfront treatment for 44.4% (n = 84) of patients. Most (41.8%, n = 79) patients had undergone 1 resection prior to SRS. The median tumor volume at the time of SRS was 5.6 cm3 (0.2–54.8 cm3). The median margin dose was 14 Gy (range 5–35 Gy). The volumes of the parasellar meningioma were determined on follow-up scans, computed by segmenting the meningioma on a slice-by-slice basis with numerical integration using the trapezoidal rule.RESULTSThe median follow-up was 71 months (range 6–298 months). Tumor volume control was achieved in 91.5% (n = 173). Tumor progression was documented in 8.5% (n = 16), equally divided among infield recurrences (4.2%, n = 8) and out-of-field recurrences (4.2%, n = 8). Post-SRS, new or worsening CN deficits were observed in 54 instances, of which 19 involved trigeminal nerve dysfunction and were 18 related to optic nerve dysfunction. Of these, 90.7% (n = 49) were due to tumor progression and only 9.3% (n = 5) were attributable to SRS. Overall, this translates to a 2.64% (n = 5/189) incidence of direct SRS-related complications. These patients were treated with repeat SRS (6.3%, n = 12), repeat resection (2.1%, n = 4), or both (3.2%, n = 6). For patients treated with a margin dose ≥ 16 Gy, the 2-, 4-, 6-, 8-, 10-, 12-, and 15-year actuarial progression-free survival rates are 100%, 100%, 95.7%, 95.7%, 95.7%, 95.7%, and 95.7%, respectively. Patients treated with a margin dose < 16 Gy, had 2-, 4-, 6-, 8-, 10-, 12-, and 15-year actuarial progression-free survival rates of 99.4%, 97.7%, 95.1%, 88.1%, 82.1%, 79.4%, and 79.4%, respectively. This difference was deemed statistically significant (p = 0.043). Reviewing the volumetric patient-specific measurements, the early follow-up volumetric measurements (at the 3-year follow-up) reliably predicted long-term volume changes and tumor volume control (at the 10-year follow-up) (p = 0.029).CONCLUSIONSSRS is a durable and minimally invasive treatment modality for benign parasellar meningiomas. SRS offers high rates of growth control with a low incidence of neurological deficits compared with other treatment modalities for meningiomas in this region. Volumetric regression or stability during short-term follow-up of 3 years after SRS was shown to be predictive of long-term tumor control.

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Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors

Acta Endocrinologica ◽

10.1530/eje.1.02298 ◽

2006 ◽

Vol 155 (6) ◽

pp. 823-829 ◽

Cited By ~ 155

Author(s):

Emanuele Ferrante ◽

Monica Ferraroni ◽

Tristana Castrignanò ◽

Laura Menicatti ◽

Mascia Anagni ◽

...

Keyword(s):

Pituitary Adenoma ◽

Pituitary Tumors ◽

Term Outcome ◽

Long Term Outcome ◽

North West ◽

Presenting Symptoms ◽

Post Surgery ◽

First Choice

Objective: The long-term outcome of non-functioning pituitary adenoma (NFPA) patients is not clearly established, probably due to the low annual incidence and prolonged natural history of these rare tumors. The aim of this study was to evaluate clinical data at presentation and long-term post-surgery and radiotherapy outcome in a cohort of patients with NFPA. Design and methods: A computerized database was developed using Access 2000 software (Microsoft Corporation, 1999). Retrospective registration of 295 NFPA patients was performed in seven Endocrinological Centers of North West Italy. Data were analyzed by STATA software. Results: The main presenting symptoms were visual defects (67.8%) and headache (41.4%) and the most frequent pituitary deficit was hypogonadism (43.3%), since almost all tumors were macroadenomas (96.5%). Surgery was the first choice treatment (98% of patients) and total debulking was achieved in 35.5%. Radiotherapy was performed as adjuvant therapy after surgery in 41% of patients. At the follow-up, recurrence occurred in 19.2% of patients without post-surgical residual tumor after 7.5 ± 2.6 years, regrowth in 58.4% of patients with post-surgical remnant after 5.3 ± 4.0 years and residue enlargement in 18.4% of patients post-surgically treated with radiotherapy after 8.1 ± 7.3 years. Conclusions: Our database indicates that the goal of a definitive surgical cure has been achieved during the last decade in a low percentage of patients with NFPA. This tumor database may help to reduce the delay between symptom onset and diagnosis, to assess prognostic parameters for the follow-up of patients with different risk of recurrence and to define the efficacy and safety of different treatments and their association with mortality/morbidity.

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Endoscopic Endonasal Transoculomotor Triangle Approach for the Resection of a Pituitary Adenoma with Ambient Cistern Extension

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625942 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S283-S283

Author(s):

Georgios Zenonos ◽

Eric Wang ◽

Juan Fernandez-Miranda

Keyword(s):

Pituitary Adenoma ◽

Clinical Outcome ◽

Outcome Measures ◽

Vision Loss ◽

Pituitary Tumors ◽

Recurrence Free Survival ◽

Endoscopic Endonasal ◽

Free Survival ◽

Ambient Cistern

Objectives The current video presents the nuances of the endoscopic endonasal transoculomotor triangle approach for the resection of a pituitary adenoma with extension into the ambient cistern. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon at a teaching academic institution. Participants The case refers to a 62-year-old female who presented with vision loss and headaches, and was found to have a pituitary adenoma with extension into the ambient cistern. Main Outcome Measures The main outcome measures consist of the reversal of the patient symptoms (headaches), the recurrence-free survival based on imaging, as well as the absence of any complications. Results The patient's headaches improved. There was no evidence of recurrence. Conclusions The endoscopic endonasal transoculomotor triangle approach is safe and effective for addressing pituitary tumors which extend into the ambient cistern.The link to the video can be found at: https://youtu.be/EBLwEWhohxY.

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Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

Stereotactic and Functional Neurosurgery ◽

10.1159/000508737 ◽

2020 ◽

Vol 98 (6) ◽

pp. 371-377

Author(s):

Won Jae Lee ◽

Kyung-Rae Cho ◽

Jung-Won Choi ◽

Doo-Sik Kong ◽

Ho Jun Seol ◽

...

Keyword(s):

Pituitary Adenoma ◽

Gamma Knife ◽

Cavernous Sinus ◽

Tumor Volume ◽

Gamma Knife Radiosurgery ◽

Primary Treatment ◽

Tumor Control ◽

Nonfunctioning Pituitary Adenoma ◽

Maximal Diameter

Objectives: Surgical resection of nonfunctioning pituitary adenoma (NFPA) invading the cavernous sinus (CS) remains a challenging and significant factor associated with incomplete resection. The residual tumor in CS is usually treated with adjuvant stereotactic radiosurgery (SRS), but there is little information concerning SRS as an initial treatment for CS-invading NFPA. In this study, we investigated the tumor control rate and clinical outcomes of the patients who received primary gamma knife radiosurgery (GKRS) for CS-invading NFPA. Methods: This was a single-institute retrospective analysis of 11 patients. CS invasion of tumor was categorized using the modified Knosp grading system. The median tumor volume and maximal diameter were 1.6 cm3 (range 0.4–6.5) and 17.2 mm (range 11.6–23.3), respectively. The median clinical follow-up period was 48.5 months (range 16.4–177.8). The median prescription dose at tumor margin was 15 Gy (range 11–25) and median prescription isodose was 50% (range 45–50). The maximum radiation dose to optic chiasm and optic nerve were 7.2 Gy (range 3.4–9.2) and 7.5 Gy (range 4.5–11.5), respectively. Results: Tumor control was achieved in all patients. The median tumor volume and maximal diameter at last follow-up were 0.4 cm3 (range 0.1–2.3) and 11.4 mm (range 4.7–19.5), respectively. The median volume reduction rate was 52% (range 33–88). Six patients showed downgrading of modified Knosp grade after GKRS. No patients developed GKRS-related complications such as hypopituitarism or visual disturbance. Conclusions: SRS may be an alternative primary treatment option for CS-invading NFPA if there is no urgent and absolute indication for surgery such as optic apparatus compression.

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Hypopituitarism after Gamma Knife surgery for postoperative nonfunctioning pituitary adenoma

Journal of Neurosurgery ◽

10.3171/2018.7.gks181589 ◽

2018 ◽

Vol 129 (Suppl1) ◽

pp. 47-54

Author(s):

Ji Woong Oh ◽

Kyoung Su Sung ◽

Ju Hyung Moon ◽

Eui Hyun Kim ◽

Won Seok Chang ◽

...

Keyword(s):

Pituitary Adenoma ◽

Tumor Volume ◽

Pituitary Stalk ◽

Tumor Control ◽

Hormonal Changes ◽

Maximal Dose ◽

Normal Gland ◽

Long Term Follow Up

OBJECTIVEThis study investigated long-term follow-up data on the combined pituitary function test (CPFT) in patients who had undergone transsphenoidal surgery (TSS) for nonfunctioning pituitary adenoma (NFPA) to determine the clinical parameters indicative of hypopituitarism following postoperative Gamma Knife surgery (GKS).METHODSBetween 2001 and 2015, a total of 971 NFPA patients underwent TSS, and 76 of them (7.8%) underwent postoperative GKS. All 76 patients were evaluated with a CPFT before and after GKS. The hormonal states were analyzed based on the following parameters: relevant factors before GKS (age, sex, extent of resection, pre-GKS hormonal states, time interval between TSS and GKS), GKS-related factors (tumor volume; radiation dose to tumor, pituitary stalk, and normal gland; distance between tumor and stalk), and clinical outcomes (tumor control rate, changes in hormonal states, need for hormone-related medication due to hormonal changes).RESULTSOf the 971 NFPA patients, 797 had gross-total resection (GTR) and 174 had subtotal resection (STR). Twenty-five GTR patients (3.1%) and 51 STR patients (29.3%) underwent GKS. The average follow-up period after GKS was 53.5 ± 35.5 months, and the tumor control rate was 96%. Of the 76 patients who underwent GKS, 23 were excluded due to pre-GKS panhypopituitarism (22) or loss to follow-up (1). Hypopituitarism developed in 13 (24.5%) of the remaining 53 patients after GKS. A higher incidence of post-GKS hypopituitarism occurred in the patients with normal pre-GKS hormonal states (41.7%, 10/24) than in the patients with abnormal pre-GKS hormonal states (10.3%, 3/29; p = 0.024). Target tumor volume (4.7 ± 3.9 cm3), distance between tumor and pituitary stalk (2.0 ± 2.2 mm), stalk dose (cutoffs: mean dose 7.56 Gy, maximal dose 12.3 Gy), and normal gland dose (cutoffs: maximal dose 13.9 Gy, minimal dose 5.25 Gy) were factors predictive of post-GKS hypopituitarism (p < 0.05).CONCLUSIONSThis study analyzed the long-term follow-up CPFT data on hormonal changes in NFPA patients who underwent GKS after TSS. The authors propose a cutoff value for the radiation dose to the pituitary stalk and normal gland for the prevention of post-GKS hypopituitarism.

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Visual Field Preservation after Multisession CyberKnife Radiosurgery for Perioptic Lesions

Neurosurgery ◽

10.1227/01.neu.0000223512.09115.3e ◽

2006 ◽

Vol 59 (2) ◽

pp. 244-254 ◽

Cited By ~ 132

Author(s):

John R. Adler ◽

Iris C. Gibbs ◽

Putipun Puataweepong ◽

Steven D. Chang

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Tumor Progression ◽

Tumor Volume ◽

Unique Challenge ◽

Fractionated Radiotherapy ◽

Number Of Patients ◽

Clinical Series ◽

Cyberknife Radiosurgery

Abstract OBJECTIVE: The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings. METHODS: Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a “short segment” of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months. RESULTS: After a mean visual field follow-up of 49 months (range, 6–96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes. CONCLUSION: Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.

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Tumor shrinkage after transsphenoidal surgery for nonfunctioning pituitary adenoma

Journal of Neurosurgery ◽

10.3171/2013.8.jns13790 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1447-1452 ◽

Cited By ~ 18

Author(s):

Sven Berkmann ◽

Sven Schlaffer ◽

Michael Buchfelder

Keyword(s):

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Multivariate Regression ◽

Tumor Volume ◽

Pituitary Surgery ◽

Intraoperative Mri ◽

Tumor Shrinkage ◽

History Of ◽

Tumor Remnant

Object Volume reduction of nonfunctioning pituitary adenomas has been described, for example, after radiotherapy and pituitary tumor apoplexy. Even when considerable remnants remain after surgery, spontaneous shrinkage and relief of mass lesion symptoms can sometimes occur. The aim of this study was to assess shrinkage of tumor residues after transsphenoidal surgery and to identify predictors of tumor shrinkage. Methods A total of 140 patients with postoperative remnants of nonfunctioning pituitary adenomas treated at the Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany, were included in this study. All patients underwent transsphenoidal procedures with guidance by 1.5-T intraoperative MRI. The intraoperative images of remnants were compared with images taken at 3 months and at 1 year after surgery. The possible predictors analyzed were age; sex; preoperative and intraoperative tumor dimensions; tumor growth pattern; endocrinological, ophthalmological, and histological characteristics; and history of previous pituitary surgery. For statistical analyses, the Fisher's exact test, Mann-Whitney U-test, and multivariate regression table analysis were used. Results Follow-up imaging 3 months after surgery showed tumor remnant shrinkage of 0.5 ± 0.6 cm3 for 70 (50%) patients. This reduction was 89% ± 20% of the residual volume depicted by intraoperative MRI. In 45 (64%) patients, the remnants disappeared completely. Age, sex, and preoperative tumor volume did not significantly differ between the shrinkage and no-shrinkage groups. Positive predictors for postoperative shrinkage were cystic tumor growth (p = 0.02), additional resection of tumor remnants guided by intraoperative MRI (p = 0.04), smaller tumor volume (p = 0.04), and smaller craniocaudal tumor diameter of remnants (p = 0.0014). Negative predictors were growth into the cavernous sinus (p = 0.009), history of previous pituitary surgery (p = 0.0006) and tumor recurrence (p = 0.04), and preoperative panhypopituitarism (p = 0.04). Multivariate regression analysis indicated a positive correlation between tumor shrinkage and smaller tumor remnants (p < 0.0001) and no history of previous pituitary surgery (p = 0.003). No spontaneous change in tumor remnant volume was detected between 3 months and 1 year postoperatively. During a mean follow-up time of 2.7 years, 1 (2%) patient with postoperative tumor shrinkage had to undergo another operation because of tumor progression. Conclusions Spontaneous volume reduction of nonfunctioning pituitary adenoma remnants can occur within 3 months after surgery. Predictors of shrinkage are smaller tumor remnant volume and no history of previous pituitary surgery.

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Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials

Acta Endocrinologica ◽

10.1530/eje-08-0205 ◽

2008 ◽

Vol 159 (5) ◽

pp. 517-523 ◽

Cited By ~ 43

Author(s):

Camilo Jimenez ◽

Pia Burman ◽

Roger Abs ◽

David R Clemmons ◽

William M Drake ◽

...

Keyword(s):

Clinical Trials ◽

Radiation Therapy ◽

Tumor Growth ◽

Pituitary Tumor ◽

Tumor Volume ◽

Somatostatin Analogs ◽

Pituitary Tumors ◽

Magnetic Resonance Images

ObjectiveWe examined pituitary tumor volumes in patients treated with pegvisomant for 18 months or longer, and in whom the tumors were monitored for at least 3 years. We present details on 9 of 304 patients in clinical trials with pegvisomant who experienced tumor growth within the first year of treatment.MethodMagnetic resonance images prior to start of pegvisomant and at last follow-up were examined in 43 patients (14% of participating patients). Twenty-nine had received prior radiation therapy (18% of irradiated patients) and all but five received somatostatin analogs between periods of pegvisomant treatment.ResultsAt follow-up, the median tumor volume was 0.6 cc (range 0.0–19.7 cc), in comparison with 1.6 cc (0.0–19.7 cc) at baseline (P<0.001). Twenty-five patients, of which 23 received radiation therapy, had tumor volume reduction. Seventeen patients had no significant change. One patient, who had not received radiation therapy, had an increase in tumor volume from 1.61 to 1.93 cc. Of the nine patients with tumor growth, six had progressive growth before initiating pegvisomant. Two patients with stable tumors while on octreotide experienced enlargement after octreotide discontinuation but remained stable on long-term pegvisomant therapy.ConclusionThe present data indicate that pegvisomant does not promote tumor growth and suggest that the nine observed cases of tumor progression, which occurred within 8 months after commencing pegvisomant, are likely rebound expansions after discontinuation of somatostatin analogs and/or the natural history of aggressively growing pituitary tumors. Continued long-term surveillance of tumor volume, particularly in non-irradiated patients, is recommended.

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