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Empirical versus progression-guided stereotactic radiosurgery for non-functional pituitary macroadenomas after subtotal resection

  • Cheng-Chia LeeEmail author
  • Huai-Che Yang
  • Ching-Jen Chen
  • Chung-Jung Lin
  • Hsiu-Mei Wu
  • Wen-Yuh Chung
  • Cheng-Ying Shiau
  • Wan-Yuo Guo
  • David Hung-Chi Pan
Clinical Study

Abstract

Objective

There is a lack of consensus regarding whether if residual non-functional macroadenomas (NFM) should undergo empirical stereotactic radiosurgery (SRS) or be monitored until tumor progression before SRS treatment. The aim of this study is to compare the risks and benefits of empirical versus progression-guided SRS for NFM after subtotal resection.

Methods

This is a retrospective study of consecutive NFM patients who subtotal surgical resection followed by SRS between 1999 and 2014. Patients were dichotomized into two groups: empirical SRS (SRS without evidence of tumor progression) and progression-guided SRS (SRS after demonstration of tumor progression) groups. Tumor response was categorized into: (1) regression, ≥ 10% decrease in tumor volume; (2) stable, < 10% increase or decrease in tumor volume; and (3) progression, ≥ 10% increase in tumor volume. Tumor control comprised stable tumor response and tumor regression.

Results

Of the 112 patients who underwent SRS for NFM, 106 patients were treated for residual NFM after surgical resection, and included in the final analysis. The empirical SRS and progression-guided SRS groups comprised 46 and 60 patients, respectively. Overall tumor control rate was 88.7%. Higher rate of tumor control was achieved in the empirical SRS group compared to the progression-guided SRS group (95.65% vs. 83.33%, p = 0.047). Rates of new visual field deficit, cranial neuropathy and endocrinopathy were comparable between the two groups. Empirical SRS group had higher rates of progression-free survival compared to progression-guided SRS group (p = 0.015). Actuarial progression-free survival rates for the empirical SRS group were 93.2%, 93.2%, and 81.5% at 3, 5, and 10 years after SRS. Actuarial progression-free survival rates for the progression-guided SRS were 86.4%, 82.1%, and 68.4% at 3, 5, and 10 years after SRS.

Conclusion

Empirical SRS offers higher rates of tumor control and progression-free survival compared to progression-guided SRS in patients with residual NFM after surgical resection. Rates of new hypopituitarism and cranial neuropathies were comparable between the two groups.

Keywords

Gamma Knife Nonfunctional Pituitary adenoma Radiosurgery 

Abbreviations

ACTH

Adrenocorticotropic hormone

FSH

Follicle-stimulating hormone

GH

Growth hormone

SRS

Stereotactic radiosurgery

Gy

Gray

IGF-1

Insulin-like growth factor-1

LH

Luteinizing hormone

NFA

Nonfunctional pituitary adenomas

SRS

Stereotactic radiosurgery

TSH

Thyrotroph-stimulating hormone

TSS

Transsphenoidal surgery

Notes

Funding

This study has no funding supported.

Compliance with ethical standards

Conflict of interest

All author declare that he/she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Neurological InstituteTaipei Veterans General HospitalTaipeiTaiwan, ROC
  2. 2.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
  3. 3.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan, ROC
  4. 4.Cancer CenterTaipei Veterans General HospitalTaipeiTaiwan, ROC
  5. 5.Department of Neurological SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  6. 6.Department of Neurosurgery, Shuang Ho HospitalTaipei Medical UniversityTaipeiTaiwan, ROC

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