Brain Tumor Res Treat.  2016 Apr;4(1):1-7. 10.14791/btrt.2016.4.1.1.

Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma

• Lee MH
• Lee JH
• Seol HJ
• Lee JI
• Kim JH
• Kong DS
• Nam DH

• KMID: 2165226
• DOI: http://doi.org/10.14791/btrt.2016.4.1.1

Abstract

BACKGROUND
Non-functioning pituitary adenomas (NFPA) are clinically challenging because they present at a late stage with local mass effects or hypopituitarism. Surgery for non-functioning pituitary adenoma requires a special strategic approach for both minimal morbidity and radical resection. However, the clinical predictive factors associated with recurrence are limited. Here, we investigated optimal treatment of non-functioning pituitary adenoma.
METHODS
We enrolled 289 patients who presented with non-functioning pituitary adenoma between January 2000 and January 2012 and who had received follow-up for at least one year for this retrospective study. Of these patients, 152 were male and 137 were female, with a median age of 51 years (range 15.79 years) and a median follow-up of four years (range 1.12.6 years). Characteristics of patients and tumors were reviewed with electronic medical records and radiologic images, retrospectively.
RESULTS
Of the tumors, 193 were gross-totally resected, 53 were near-totally resected, and 43 were sub-totally resected. The extent of resection and adjuvant radiotherapy were both statistically significant prognostic factors of recurrence. Immunohistochemistry of tumor specimens did not yield consistent results.
CONCLUSION
With a high rate of recurrence, NFPA should be closely followed-up over a long-term period. Improvement of surgical techniques with advanced surgical equipment and adjuvant radiosurgery would lead to reduce the recurrence rate and improve patients' outcome.

Keyword

Nonfunctioning; Pituitary adenoma; Radiotherapy; Recurrence; Radiosurgery

MeSH Terms

Electronic Health Records
Female
Follow-Up Studies
Humans
Hypopituitarism
Immunohistochemistry
Male
Pituitary Neoplasms*
Radiosurgery
Radiotherapy
Radiotherapy, Adjuvant
Recurrence*
Retrospective Studies
Surgical Equipment

Figure

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  Fig. 1 Progression-free survival between groups based on extent of resection and administration of adjuvant treatment. GTR, gross total removal; NTR, near total removal; STR, subtotal removal; Tx, treatment.

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  Fig. 2 Illustrative case. A 22-year-old male patient presented with visual field defects. A: Initial MRI showed pituitary adenoma. B: Suspicious residual mass identified after operation. C: 1-yr postoperative MRI showed progression. The patient was lost to follow-up without any further treatment. D: 6-yr postoperative MRI showed significantly progression with hydrocephalus. E: After the second operation, intra-cerebral hemorrhage with intra-ventricular hemorrhage occurred. F: An adjuvant gamma knife radiosurgery was conducted to the residual tumor.

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