Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas.

Chia-Lun Chang,Alexander T.H Wu,Kevin Sheng-Po Yuan,Szu-Yuan Wu

doi:10.3390/cancers11111658

Abstract

Background: Here, we compared the toxicity profiles of contemporary stereotactic radiosurgery (SRS), modern fractionated radiotherapy (FRT), and transsphenoidal surgery used to treat nonfunctioning pituitary macroadenomas. Methods: We included the data of patients with nonfunctioning pituitary macroadenomas. To compare treatment outcomes, the patients were categorized groups 1 (those receiving modern FRT), 2 (those receiving contemporary SRS), and 3 (those receiving transsphenoidal surgery). The multivariable Cox proportional hazards regression analysis was performed to yielded adjusted hazard ratios (aHRs) and their 95% CIs for local recurrence in groups 2 and 3 compared with group 1. Results: We included the data of 248 patients with nonfunctioning pituitary macroadenomas. The analytical results revealed no significant differences in second primary brain or head and neck cancer, hypopituitarism, or optic nerve injury between the three cohorts. The multivariable Cox proportional hazards regression analysis revealed that compared with group 1, the aHRs (95% CIs) for stroke risk in groups 2 and 3 were 0.37 (0.14–0.99) and 0.51 (0.31–0.84), respectively. Conclusion: Contemporary SRS and transsphenoidal surgery for nonfunctioning pituitary macroadenoma treatment have equivalent toxicity profiles. However, modern FRT for nonfunctioning pituitary macroadenoma treatment might considerably increase stroke risk.

Highlights

30% of pituitary tumors are clinically nonfunctioning pituitary adenomas that do not secrete an excess amount of hormones [1,2,3]
After reviewing 2006 to 2015 Taiwan Cancer Registry (TCR) data, we included the data of 248 patients with nonfunctioning pituitary macroadenomas in our study (Table 1)
No significant differences in sex, HTN, atrial fibrillation (AF), hyperlipidemia, or diabetes mellitus (DM)

Summary

Introduction

30% of pituitary tumors are clinically nonfunctioning pituitary adenomas that do not secrete an excess amount of hormones [1,2,3]. They are often discovered incidentally during imaging procedures conducted for reasons other than pituitary symptoms or disease [1,2,3]. We compared the toxicity profiles of contemporary stereotactic radiosurgery (SRS), modern fractionated radiotherapy (FRT), and transsphenoidal surgery used to treat nonfunctioning pituitary macroadenomas. The patients were categorized groups 1 (those receiving modern FRT), 2 (those receiving contemporary SRS), and 3 (those receiving transsphenoidal surgery). The multivariable Cox proportional hazards regression analysis revealed that compared with group 1, the aHRs (95% CIs) for stroke risk in groups 2 and 3 were 0.37 (0.14–0.99) and 0.51 (0.31–0.84), respectively. Conclusion: Contemporary SRS and transsphenoidal surgery for nonfunctioning pituitary macroadenoma treatment have equivalent toxicity profiles. Modern FRT for nonfunctioning pituitary macroadenoma treatment might considerably increase stroke risk

Methods

Results

Conclusion