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

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-06-24 DOI:10.1016/j.clineuro.2025.109023

Abhijit Goyal-Honavar , Subhas Konar , G. Sai Phaneendra , Nishanth Sadashiva , Shilpa Rao , Manish Beniwal , Andiperumal Raj Prabhuraj , Dwarakanath Srinivas , A. Arivazhagan , Jitendra Saini , Dhaval Shukla

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Abstract

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.

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早期辅助放疗降低无症状垂体神经内分泌皮质性肿瘤术后复发率

目的：沉默性皮质性肿瘤（sct）是一种罕见的临床和生化沉默的t窝系肿瘤。它们已被证明具有侵略性的临床行为，术前常侵犯海绵窦和蝶窦，术后复发率高。因此，我们旨在研究早期辅助放疗（EAR）对复发率的影响。方法：我们收集了2013年至2023年在我中心接受sct手术的所有患者的资料，检查他们的临床放射学资料、手术细节、手术并发症和术后复发率。我们评估了EAR对无进展生存期的影响，EAR的定义是对复发前术后影像学检测到的残余肿瘤进行放射治疗。结果本组共57例患者，其中男性24例（42.1 %），女性33例（57.9 %）。巨PitNETs 21例（36.8 %），大腺瘤36例（63.2 %）。21例（36.8 %）患者行总切除（GTR），其余36例（63.2 %）患者行次全切除。术后即刻死亡1例。36例患者中有21例（58.3 %）接受了EAR治疗，7例患者接受了伽玛刀放射手术，14例患者接受了常规放射治疗。56例中有14例复发（25% %），中位时间为17个月。当按切除程度对各组进行分层时，我们注意到非复发sct患者更频繁地使用EAR （p = 0.004）。多因素分析显示，只有EAR缺失与sct复发显著相关。结论隐匿性皮质性肿瘤为侵袭性PitNETs，复发率为25% ~ %。当不能进行GTR时，早期辅助放疗可防止复发，显著提高无进展生存期。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.