Current status and treatment modalities in metastases to the pituitary: a systematic review
Metastases to the pituitary (MP) are uncommon, accounting for 0.4% of intracranial metastases. Through advances in neuroimaging and oncological therapies, patients with metastatic cancers are living longer and MP may be more frequent. This review aimed to investigate clinical and oncological features, treatment modalities and their effect on survival.
A systematic review was performed according to PRISMA recommendations. All cases of MP were included, excepted primary pituitary neoplasms and autopsy reports. Descriptive and survival analyses were then conducted.
The search identified 2143 records, of which 157 were included. A total of 657 cases of MP were reported, including 334 females (50.8%). The mean ± standard deviation age was 59.1 ± 11.9 years. Lung cancer was the most frequent primary site (31.0%), followed by breast (26.2%) and kidney cancers (8.1%). Median survival from MP diagnosis was 14 months. Overall survival was significantly different between lung, breast and kidney cancers (P < .0001). Survival was impacted by radiotherapy (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.35–0.67; P < .0001) and chemotherapy (HR 0.58; 95% CI 0.36–0.92; P = .013) but not by surgery. Stereotactic radiotherapy tended to improve survival over conventional radiotherapy (HR 0.66; 95% CI 0.39–1.12; P = .065). Patients from recent studies (≥ 2010) had longer survival than others (HR 1.36; 95% CI 1.05–1.76; P = .0019).
This systematic review based on 657 cases helped to better identify clinical features, oncological characteristics and the effect of current therapies in patients with MP. Survival patterns were conditioned upon primary cancer histologies, the use of local radiotherapy and systemic chemotherapy, but not by surgery.
KeywordsPituitary Metastasis Sella Radiotherapy Surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no relevant financial relationships or conflict of interest to disclose.
This research did not involve humans, and no informed consent was required.
- 14.Priddy B, Hardesty DA, Beer-Furlan A et al (2017) Cerebrospinal fluid leak rhinorrhea after systemic erlotinib chemotherapy for metastatic lung cancer: a familiar problem from an unfamiliar culprit. World Neurosurg 108:992.e11–992.e14. https://doi.org/10.1016/j.wneu.2017.08.183 CrossRefGoogle Scholar
- 15.Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. https://doi.org/10.1371/journal.pmed.1000100 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Houck WA, Olson KB, Horton J (1970) Clinical features of tumor metastasis to the pituitary. Cancer 26:656–659. https://doi.org/10.1002/1097-0142(197009)26:3%3c656:aid-cncr2820260325%3e3.0.co;2-m CrossRefPubMedGoogle Scholar
- 21.Kimmel DW, O’Neill BP (1983) Systemic cancer presenting as diabetes insipidus. Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus. Cancer 52:2355–2358. https://doi.org/10.1002/1097-0142(19831215)52:12%3c2355:aid-cncr2820521232%3e3.0.co;2-j CrossRefPubMedGoogle Scholar