Progression of potentially aggressive PitNETs after radiotherapy: risk factors, management, and outcomes.

IF 5.3 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

European Journal of Endocrinology Pub Date : 2025-07-04 DOI:10.1093/ejendo/lvaf136

Fabio Bioletto, Caroline Bogeat, Maxime Barat, Nesrine Benanteur, Laurence Guignat, Mirella Hage, Cyril Garcia, Valentin Calugaru, Julian Jacob, Jennifer Arrondeau, Lionel Groussin, Xavier Bertagna, Jérôme Bertherat, Chiara Villa, Anne Jouinot, Bertrand Baussart, Guillaume Assié

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引用次数: 0

Abstract

Objective: Radiotherapy plays a relevant role in uncontrolled pituitary neuroendocrine tumors (PitNETs). Radiotherapy controls tumor progression in most cases, but not always. Prognostic factors for tumor progression after radiotherapy remain poorly defined. The aim was to evaluate tumor progression after radiotherapy, to identify risk factors, and to report management and outcomes in a cohort of PitNETs with uncontrolled progression.

Design: Retrospective, single-center, observational study.

Methods: In total, 123 consecutive patients who underwent radiotherapy for PitNETs and were followed at Cochin Hospital between 2000 and 2022 were included. Indication for radiotherapy was uncontrolled tumor progression (80%), adjuvant (9%) or uncontrolled secretion (11%). Median follow-up after radiotherapy was 10.0 years.

Results: Tumor progression after radiotherapy was observed in 28/123(23%) patients. Higher risk of progression was associated with lactotroph and corticotroph tumor types (HR[95%CI] 12.0[1.2-117.1] and 9.3[1.3-69.6], respectively), male sex (3.7[1.6-8.4]), and necrotic-hemorrhagic changes before radiotherapy on MRI (3.1[1.1-8.4]). Surgery, temozolomide and re-irradiation were the most frequent treatments for the management of patients with tumor progression after radiotherapy, used in 18/28(64%), 16/28(57%) and 8/28(29%) cases, respectively. The most common complication of radiotherapy was the new onset of pituitary deficits, observed in 41% of cases; other complications, including radiation-induced neuroinflammation, cerebrovascular events, and second brain tumors, were rare. Three patients developed metastases, and 6 patients died because of tumor progression.

Conclusions: Lactotroph and corticotroph PitNETs, in male patients, and/or with necrotic-hemorrhagic changes are at higher risk of progression after radiotherapy. Patients with progression after radiotherapy require additional heavy treatments with variable outcome.

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放射治疗后潜在侵袭性PitNETs的进展：危险因素、管理和结果。

目的：放疗在未控制的垂体神经内分泌肿瘤（PitNETs）中发挥重要作用。放疗在大多数情况下控制肿瘤进展，但并非总是如此。放疗后肿瘤进展的预后因素仍不明确。目的是评估放疗后的肿瘤进展，确定危险因素，并报告进展不受控制的PitNETs队列的管理和结果。设计：回顾性、单中心、观察性研究。方法：共纳入2000年至2022年期间在科钦医院连续接受PitNETs放疗的123例患者。放疗的适应症为肿瘤进展不受控制（80%）、辅助治疗（9%）或分泌不受控制（11%）。放疗后中位随访时间为10.0年。结果：放疗后肿瘤进展28/123（23%）。较高的进展风险与嗜乳性和糖皮质性肿瘤类型（HR[95%CI]分别为12.0[1.2-117.1]和9.3[1.3-69.6]）、男性（3.7[1.6-8.4]）以及放疗前MRI显示的坏死性出血改变（3.1[1.1-8.4]）相关。手术、替莫唑胺和再照射是放疗后肿瘤进展患者最常用的治疗方法，分别占18/28（64%）、16/28（57%）和8/28（29%）。放疗最常见的并发症是新发垂体功能缺损，占41%；其他并发症，包括辐射引起的神经炎症、脑血管事件和第二脑肿瘤，都很少见。3例发生转移，6例因肿瘤进展死亡。结论：嗜乳性和皮质性PitNETs，在男性患者中，和/或有坏死性出血改变的患者在放疗后进展的风险更高。放疗后进展的患者需要额外的重治疗，治疗结果不一。

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来源期刊

European Journal of Endocrinology 医学-内分泌学与代谢

CiteScore

9.80

自引率

3.40%

发文量

354

审稿时长

1 months

期刊介绍： European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.