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Aggressive pituitary neuroendocrine tumors: current practices, controversies, and perspectives, on behalf of the EANS skull base section

  • Review Article - EANS Affairs
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Abstract

Aggressive pituitary neuroendocrine tumors (APT) account for 10% of pituitary tumors. Their management is a rapidly evolving field of clinical research and has led pituitary teams to shift toward a neuro-oncological-like approach. The new terminology “Pituitary neuroendocrine tumors” (PitNet) that was recently proposed to replace “pituitary adenomas” reflects this change of paradigm. In this narrative review, we aim to provide a state of the art of actual knowledge, controversies, and recommendations in the management of APT. We propose an overview of current prognostic markers, including the recent five-tiered clinicopathological classification. We further establish and discuss the following recommendations from a neurosurgical perspective: (i) surgery and multi-staged surgeries (without or with parasellar resection in symptomatic patients) should be discussed at each stage of the disease, because it may potentialize adjuvant medical therapies; (ii) temozolomide is effective in most patients, although 30% of patients are non-responders and the optimal timeline to initiate and interrupt this treatment remains questionable; (iii) some patients with selected clinicopathological profiles may benefit from an earlier local radiotherapy and/or chemotherapy; (iv) novel therapies such as VEGF-targeted therapies and anti-CTLA-4/anti-PD1 immunotherapies are promising and should be discussed as 2nd or 3rd line of treatment. Finally, whether neurosurgeons have to operate on “pituitary adenomas” or “PitNets,” their role and expertise remain crucial at each stage of the disease, prompting our community to deal with evolving concepts and therapeutic resources.

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Authors and Affiliations

  1. Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France

    Sam Ng

  2. Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland

    Mahmoud Messerer, Giulia Cossu & Roy T. Daniel

  3. Department of Neurosurgery, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France

    Julien Engelhardt

  4. Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium

    Michaël Bruneau

  5. Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

    Jan Frederick Cornelius

  6. Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy

    Luigi Maria Cavallo

  7. Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France

    Sebastien Froelich

  8. Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland

    Torstein R. Meling

  9. Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew’s and The Royal London Hospital, London, UK

    Dimitrios Paraskevopoulos

  10. Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany

    Henry W. S. Schroeder

  11. Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany

    Marcos Tatagiba

  12. Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain

    Idoya Zazpe

  13. Vascular and Neuro-Oncological Surgical Departement, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France

    Moncef Berhouma

  14. Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Edward R. Laws

  15. Department of Neurosurgery, Medical University of Vienna, Vienna, Austria

    Engelbert Knosp

  16. Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany

    Michael Buchfelder

  17. Department of Neurosurgery, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France

    Henri Dufour

  18. Department of Neurosurgery, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Stéphane Gaillard

  19. Skull Base and Pituitary Neurosurgical Department, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France

    Timothée Jacquesson & Emmanuel Jouanneau

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  1. Sam Ng
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  2. Mahmoud Messerer
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  3. Julien Engelhardt
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  4. Michaël Bruneau
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  5. Jan Frederick Cornelius
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  6. Luigi Maria Cavallo
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  7. Giulia Cossu
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  8. Sebastien Froelich
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  9. Torstein R. Meling
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  10. Dimitrios Paraskevopoulos
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  11. Henry W. S. Schroeder
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  12. Marcos Tatagiba
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  13. Idoya Zazpe
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  14. Moncef Berhouma
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  15. Roy T. Daniel
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Corresponding author

Correspondence to Sam Ng.

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This research did not involve humans, and no informed consent was required.

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The authors declare no competing interests.

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Comments

I congratulate EANS skull Base Section, and all the authors involved for this exercise. This is an excellent review of the current state of knowledge and adds value to the literature.

Basant Misra

India

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Ng, S., Messerer, M., Engelhardt, J. et al. Aggressive pituitary neuroendocrine tumors: current practices, controversies, and perspectives, on behalf of the EANS skull base section. Acta Neurochir 163, 3131–3142 (2021). https://doi.org/10.1007/s00701-021-04953-6

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