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Mid-term prognosis of non-functioning pituitary adenomas with high proliferative potential: really an aggressive variant?

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Abstract

Pituitary adenomas with high proliferation rate and rapid growth are well known, but the clinical characteristics, prognosis, and treatment algorithm remain unclear. The clinical characteristics and mid-term prognosis of patients with non-functioning pituitary adenomas with high proliferative potential were retrospectively investigated. This study identified 53 patients with Ki-67 labeling index of > 3% among 845 patients with non-functioning pituitary adenoma (6.3%) initially treated by surgery. Prophylactic treatment was not applied for patients with residual tumor, but salvage treatment was performed if tumor progression was identified within the follow-up period. Twenty-two patients remained progression-free, whereas 31 patients suffered tumor progression. Comparison of gross total removal (n = 22) and non-total removal (n = 31) groups showed significantly longer progression-free period in the former group (P < 0.001). As salvage treatment gamma knife radiosurgery was applied for 11 patients resulting in 10 patients remaining progression-free and regrowth in 1 patient. Fractionated irradiation was applied for 10 patients, resulting in 2 patients remaining progression-free, deaths in 5 patients including 3 of transformation to pituitary carcinoma, dementia in 1 patient caused by frontal lobe dysfunction, and progression in 2 patients requiring additional surgery and gamma knife radiosurgery. Temozolomide was administered in 2 patients, resulting in deaths in both patients including 1 transformation to pituitary carcinoma. Total removal and gamma knife radiosurgery can result in good outcome. However, the prognosis is extremely poor for patients inadequate for gamma knife radiosurgery. Development of new salvage treatments is essential.

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Acknowledgements

The authors express acknowledgements to Dr. Hidetoshi Ikeda (Southern Tohoku Hospital, Koriyama, Fukushima, Japan) for his pathological advice in this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan

    Yoshikazu Ogawa

  2. Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Miyagi, Japan

    Hidefumi Jokura

  3. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Kuniyasu Niizuma & Teiji Tominaga

Authors
  1. Yoshikazu Ogawa
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  2. Hidefumi Jokura
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  3. Kuniyasu Niizuma
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  4. Teiji Tominaga
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Correspondence to Yoshikazu Ogawa.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Ogawa, Y., Jokura, H., Niizuma, K. et al. Mid-term prognosis of non-functioning pituitary adenomas with high proliferative potential: really an aggressive variant?. J Neurooncol 137, 543–549 (2018). https://doi.org/10.1007/s11060-017-2740-1

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  • DOI: https://doi.org/10.1007/s11060-017-2740-1

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