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

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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.

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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

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Funding

This study has no funding supported.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Cheng-Chia Lee, Huai-Che Yang, Wen-Yuh Chung & David Hung-Chi Pan

  2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Chung-Jung Lin, Hsiu-Mei Wu, Cheng-Ying Shiau & Wan-Yuo Guo

  3. School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC

    Cheng-Chia Lee, Huai-Che Yang, Chung-Jung Lin, Hsiu-Mei Wu, Wen-Yuh Chung & Wan-Yuo Guo

  4. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Cheng-Ying Shiau

  5. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA

    Ching-Jen Chen

  6. Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC

    David Hung-Chi Pan

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  1. Cheng-Chia Lee
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Correspondence to Cheng-Chia Lee.

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Lee, CC., Yang, HC., Chen, CJ. et al. Empirical versus progression-guided stereotactic radiosurgery for non-functional pituitary macroadenomas after subtotal resection. J Neurooncol 142, 291–297 (2019). https://doi.org/10.1007/s11060-019-03095-1

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