Abstract
Background: To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression.Methods: Two hundred and sixty-seven patients were treated surgically for pituitary tumors at our institution between 1997 and 2005. One hundred and twenty-six patients met the inclusion criteria of NFPMA. They were followed for at least 2 years.Results: At presentation, 58% of patients had objectively decreased visual function, 66% had endocrine abnormalities, and 46% had headaches. Of the entire cohort, 75% of tumors abutted the optic chiasm and 87% had suprasellar extension. Over a median follow up of 112 months from surgery, 52% of patients had evidence of radiographic tumor progression, and 39% required additional treatment. There was a significant difference freedom from progression and in the number of patients receiving additional treatment with preoperative adenoma size of < 2 vs. ≥2 cm (p < 0.05).Conclusion: Close observation with radiation therapy delayed until the time of progression is an appropriate option for patients presenting with initial adenoma size < 2 cm, and can be considered for those with initial sizes up to 4 cm, as the majority of patients do not require further intervention for 10 or more years, thereby meaningfully postponing the risks of radiotherapy.
Highlights
Pituitary adenomas are a common benign tumor arising from the pituitary gland
We present the outcome measured from date of pathologic confirmation for a cohort of non-functioning pituitary macroadenomas (NFPMA) patients managed with radiotherapy delayed until progression, and we assessed whether consequent to the decision to observe, patients experienced adverse effects of recurrences and subsequent treatment
Consecutive patients were identified from the pathology department database, which identified patients as having non-secretory adenomas
Summary
Pituitary adenomas are a common benign tumor arising from the pituitary gland. They account for 10–15% of all intracranial tumors and are classified by size and hormone secretion [1]. For patients receiving radiation therapy, different studies report increased progression free survival at 10 years between 85 and 98% [4,5,6] and of 92% at 20 years [4]. In these studies, prognostic factors include gender, [7] age, and size [5]. To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression
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