PituitaryStereotactic radiosurgery for pituitary metastases☆
Introduction
The development of a pituitary metastasis is rare within the context of cancer. The frequency of metastases confirmed at autopsy is higher, representing up to 28% of all brain metastases) [15], [11], [21]. Most patients who develop such tumors remain clinically asymptomatic [1], [14]. Although virtually all malignancies can metastasize to the pituitary gland, the most frequent is breast, followed by lung, gastrointestinal tract, and prostate [15], [17], [22]. Diabetes insipidus, with or without other signs of hypopituitarism, is the most frequent presenting symptom [6], [7], [10].
Surgical resection preceding fractionated RT is recommended if no known diagnosis of systemic cancer is present [16]. Most such patients experience the development of permanent DI and Panhypo. Whole-brain RT is typically recommended for patients with known systemic cancer [15].
Stereotactic radiosurgery facilitates submillimeter accurate delivery of radiation in a single outpatient procedure. However, the role of SRS in the treatment of pituitary metastases is not well documented because there are only few published outcome studies [[8], [19]]. This report reviews our 20-year experience with SRS for pituitary metastases. We evaluated tumor control, patient survival, pituitary function, AREs, and other variables that might affect treatment outcomes.
Section snippets
Patient population
Between 1988 and 2007, 2522 patients with brain metastases underwent SRS at the University of Pittsburgh. Eighteen (0.7%) patients had a pituitary metastasis. The series includes 11 men and 7 women with a median age of 57.6 years (range, 27.0-81.1 years). A total of 13 patients had only a pituitary metastasis, and 5 had these tumors in the context of multiple brain metastases (range, 2-7). Three patients were diagnosed at the time of a transsphenoidal surgical resection for their pituitary
Results
At last follow-up, 2 (11.1%) patients were alive and 16 patients (88.9%) had died an average of 6.0 months after radiosurgery (range, 0.5-19.4 months) and an average of 33 months after initial diagnosis of their primary site (range, 2.8-100 months). The overall survival after SRS was 65.8%, 35.9%, and 17.9% at 3, 6, and 12 months, respectively (Fig. 1). The median survival after SRS was 5.2 months. The overall survival after the initial primary diagnosis was 66.7%, 33.3%, and 13.3% at 1, 3, and
Discussion
In the face of active systemic cancer, skull-base metastases develop in approximately 4% of patients In contrast pituitary gland metastases are even rarer tumors. Many pituitary metastases remain asymptomatic and are found at incidentally autopsy. Less than 10% of pituitary metastases are symptomatic [22]. Most (≥66%) of all pituitary metastases originate from breast and lung cancer [11]. Renal cancer pituitary metastases represent as few as 2.5% of all pituitary metastases. Other primary
Acknowledgments
The work described in this report was funded by a grant (to H.K.) from the Osaka Medical Research Foundation for Incurable Diseases.
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2021, World NeurosurgeryPituitary metastasis of a breast ductal adenocarcinoma
2020, Annals of Medicine and SurgeryCitation Excerpt :Stereotaxic radiotherapy has been gradually implemented in metastatic pituitary diseases, well tolerated and associated with minimal morbidity and less complications [1]. A small cohort of 18 patients treated with stereotaxic radiosurgery demonstrated that neurological symptoms and diabetes insipidus improved in half of the patients and that tumor progression only occurred in 17% of those treated [15]; other small trials have produced equally promising results [16]. The benefits of chemotherapy for pituitary metastases are not yet fully understood.
Pituitary metastasis of malignant melanoma misdiagnosed as pituitary adenoma: A case report and systematic review of the literature
2020, NeurochirurgieCitation Excerpt :Among them, there are autopsy reports in patients with disseminated metastatic spread [13–18]. Fifteen cases of symptomatic and histologically confirmed pituitary metastases of malignant melanoma were reported in the literature [19–31]. Among them, visual disturbance was the most common presentation (10 cases).
Sellar Metastases: Diagnosis and Management
2020, Neurosurgery Clinics of North AmericaCitation Excerpt :These modalities carry the risk of injury to surrounding structures. Improved neurologic deficits and diabetes insipidus but failed anterior pituitary dysfunction improvement have been reported in previous case series.13,26 Radiosurgery achieved 67% tumor control in a previous series.27
Symptomatic Pituitary Metastases: Two Case Reports with Contrasting Clinical Presentations
2019, AACE Clinical Case ReportsCitation Excerpt :Findings associated with shorter survival are in patients over 65 years, metastasis from small cell lung cancer, and short time-frame between cancer diagnosis and PM detection (2). Interventions such as surgery, chemotherapy and radiation, including stereotactic radiosurgery, do not improve survival but may help preserve visual fields and pituitary function (2,3,9). PMs are rare but have been reported with increasing frequency in the literature.
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Conflict of interest notification: Dr Lunsford, Dr Kondziolka, and Dr Niranjan are consultants with AB Elekta. Doctor Lunsford is a stockholder in AB Elekta.