Abstract
Up to 35% of aggressive pituitary tumors recur and significantly affect mortality and quality of life. Management can be challenging and often requires multimodal treatment. Current treatment options, including surgery, conventional medical therapies such as dopamine agonists, somatostatin receptor agonists and radiotherapy, often fail to inhibit pituitary tumor growth. Recently, anti-tumor effects of chemotherapeutic drugs such as Temozolomide, Capecitabine, and Everolimus, as well as peptide receptor radionuclide therapy on aggressive pituitary tumors have been increasingly investigated and yield mixed, although sometimes promising, outcomes. The purpose of this review is to provide thorough information on non-surgical medical therapies and their efficacies and used protocols for aggressive pituitary adenomas from pre-clinical level to clinical use.
Highlights
Pituitary tumors are mostly benign and progress slowly
From the review of English literature between the years of 2012 and 2020, we found a total of 15 cases describing peptide receptor radionuclide therapy (PRRT) treatment in aggressive pituitary tumors (11 cases) and carcinomas
Aggressive pituitary tumors can be resistant to conventional therapies, including surgery, radiotherapy, and medical treatment
Summary
Pituitary tumors are mostly benign and progress slowly. Most of them are non-invasive and cured by surgery or controlled by long-term pharmacologic treatment. Carcinomas (five ACTH positive, one PRL positive, and one PIT-1 positive), five patients (71%) initially showed partial reduction of tumor size in response to CAPTEM treatment and no tumor progression for as long as 39 months. These reports include two cases of pituitary tumors treated with CAPTEM: one is a corticotroph carcinoma and the other is an aggressive corticotroph tumor [15]. Both patients had undergone previous surgical and radiologic therapies. PFS Tumor Initial tumor Total radiation dose/ Type of (month) subtype volume (ml) (number of cycles) radionuclide
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