Upfront Stereotactic Radiosurgery for Nonfunctioning Pituitary Neuroendocrine Tumors: An International, Multicenter Study.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-10-07 DOI:10.1227/neu.0000000000003799

Chloe Dumot, Georgios Mantziaris, Sam Dayawansa, Selcuk Peker, Yavuz Samanci, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled AbdelKarim, Amr M N El-Shehaby, Reem M Emad, Ahmed Ragab Abdelsalam, Roman Liscak, Jaromir May, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Douglas Kondziolka, Herwin Speckter, Ruben Mota, Anderson Brito, Shray Kumar Bindal, Ajay Niranjan, L Dade Lunsford, Carolina Gesteira Benjamin, Timoteo Almeida, Jennifer Mao, David Mathieu, Jean-Nicolas Tourigny, Manjul Tripathi, Joshua David Palmer, Jennifer Matsui, Joseph Crooks, Rodney E Wegner, Matthew J Shepard, Jason P Sheehan

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引用次数: 0

Abstract

Background and objectives: Upfront stereotactic radiosurgery (SRS) could be an option for nonfunctioning pituitary adenomas (NFPA) unsuitable for surgery. Only small series evaluate the results of upfront SRS; the aim of the study was to report patient outcomes from a large, international patient cohort.

Methods: The study evaluated tumor control and complications after single-session SRS in a multicentric cohort of untreated NFPA.

Results: In total, 132 patients (median age 51.2 [IQR: 27.1] years at SRS, median volume 2.1 [IQR: 2.9] cm3) were included. The probability of tumor control was 100% (95% CI: 100-100), 98.1% (95% CI: 94.6-100), and 92.4 (95% CI: 81.6-100) at 3, 5, and 8 years after SRS. The cumulative probability of new pituitary deficit was 11.7% (95% CI: 3.8-18.9), 24.4% (95% CI: 12.1-35.1), and 29.5% (95% CI: 12.1-26.9) at 3, 5, and 8 years, respectively. No new visual field defect occurred. Before SRS, 50 patients (37.9%) presented with a visual field defect with a complete improvement in 17 (34.7%), partial improvement in 12 (24.5%), and stability in 19 (38.8%) at a last follow-up of 2.2 (3.9) years. One patient (2.0%) worsened after SRS. Before SRS, 10 patients (7.6%) presented with an oculomotor nerve palsy. One patient (0.8%) developed a new transient nerve palsy. At a last follow-up of 2.5 (4.4) years, 5 patients (45.4 35.7%) had a stability of their palsy, 1 had a partial improvement (9.1%), and 5 (45.4%) had a complete improvement.

Conclusion: Upfront SRS represents an option for appropriately selected patients with NFPA, and it exhibits a favorable efficacy and safety profile, but a longer follow-up is required. Visual improvement is low, and careful selection of patient is required.

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无功能垂体神经内分泌肿瘤的前方立体定向放疗：一项国际多中心研究。

背景和目的：前方立体定向放射手术（SRS）可能是不适合手术的无功能垂体腺瘤（NFPA）的一种选择。只有小系列评估了前期SRS的结果；该研究的目的是报告来自大型国际患者队列的患者结果。方法：本研究对未经治疗的NFPA患者进行单次SRS后的肿瘤控制和并发症进行了评估。结果：共纳入132例患者（SRS时中位年龄51.2 [IQR: 27.1]岁，中位容积2.1 [IQR: 2.9] cm3）。SRS后3年、5年和8年肿瘤控制的概率分别为100% （95% CI: 100-100）、98.1% （95% CI: 94.6-100）和92.4 （95% CI: 81.6-100）。在3年、5年和8年时，新发垂体缺陷的累积概率分别为11.7% （95% CI: 3.8-18.9）、24.4% （95% CI: 12.1-35.1）和29.5% （95% CI: 12.1-26.9）。无新的视野缺损。在SRS之前，50例患者（37.9%）出现视野缺损，其中17例（34.7%）完全改善，12例（24.5%）部分改善，19例（38.8%）稳定，最后随访2.2（3.9）年。1例（2.0%）SRS后病情加重。SRS前，10例患者（7.6%）表现为动眼神经麻痹。1例（0.8%）发生新的一过性神经麻痹。最后随访2.5（4.4）年，5例患者（45.4% - 35.7%）麻痹稳定，1例部分改善（9.1%），5例完全改善（45.4%）。结论：对于适当选择的NFPA患者，前期SRS是一种选择，它具有良好的疗效和安全性，但需要更长的随访时间。视力改善程度低，需慎重选择患者。

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

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.