Category: Pituitary Disorders/Neuroendocrinology

Monitor: 30

30 - Residual Tumor Confers a Ten-Fold Increased Risk of Regrowth In Clinically Non-Functioning Pituitary Tumors

Thursday, Apr 25
1:30 PM – 2:00 PM

Objective :

We evaluated tumor recurrence and regrowth rates following endoscopic trans-nasal trans-sphenoidal surgical removal in a consecutive series of clinically non-functioning pituitary adenomas.


Methods : Retrospective chart review of clinical, biochemical and sellar MRI imaging findings in all endoscopic trans-nasal trans sphenoidal (TNTS) surgeries in unique patients for clinically non-functional pituitary macroadenomas by a single surgeon performed between 2008–2015 (n = 280). 93 patients met complete eligibility criteria with complete clinical, biochemical and imaging follow-up for a 3 year minimum. Longer follow-up ranging from 4-10 years in 58 patients was also examined.


Results :

Of 85 patients that were not irradiated, MRI 3 months after TNTS resection demonstrated no residual tumor in 58/85 (68.2%), equivocal findings in 12/85 (14.1%) and definite residual tumor in 15/85 (17.6%) patients. Of these non-irradiated patients, 6/85 (7.1%) that had exhibited residual tumor at 3 months demonstrated tumor regrowth by 3 years, and 2 further patients that had no visible residual at 3 months demonstrated true tumor recurrence at 3 & 6 years post-operatively respectively, for a total recurrence rate of 8/85 (9.4%). Eight of the 93 patients were irradiated between 3 months and 4 years respectively following pituitary surgery. In 3 patients, where interval tumor growth was documented, 2 exhibited residual tumor and a further had equivocal findings at the 3 months post-operative imaging. No tumor growth was demonstrated in the remaining 5 patients but radiation was advised due to large volume residual tumor. Overall, Ki-67 labelling index or KNOSP grading did not predict recurrence, although Ki-67 LI >3% was associated with recurrence in those patients that had visible residual tumor on 3-month post-operative MRI.


Discussion :

Our study demonstrates a low frequency of tumor recurrence at 3 years (1/58, 1.7%) if the 3-month post-operative MRI shows no residual tumor and supports a less frequent imaging schedule for this group. Patients with definite residual tumor visible at 3 months harbor the greatest risk for tumor growth, but it does not occur in all patients (6/15, 40%).


Conclusion :

Our experience confirms that TNTS by an experienced surgeon is an excellent modality for treatment of clinically non-functioning pituitary tumors and that attaining initial gross total resection is key to reducing rates of later recurrence in these tumors.

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Jelena Maletkovic

Professor
UCLA

Dr. Jelena Maletkovic is the endocrinologist at UCLA and she initiated this project and contributed to analysis and discussion.

Asmaa Dabbagh

Senior Research Associate
UCLA

Asmaa Dabbagh is the senior research associate and she was responsible for patient information archive and analysis

Dongyun Zhang

Assistant Project Scientist
UCLA
Los Angeles, California

Dr. Zhang has been working at UCLA-David Geffen School of Medicine, Department of Medicine for 5 years focusing on pituitary tumor basic and translational research

Abdul Zahid

Senior Research Associate
UCLA
Los Angeles, California

Mr. Abdul Zahid is the senior research associate and she was responsible for patient information archive and analysis

Marvin Bergsneider

Professor
UCLA

Dr. Marvin Bergsneider is the lead neurosurgeon at UCLA and he performs 100-200 pituitary tumor surgeries annually

Marilene B. Wang

Professor
UCLA

Dr. Marilene B. Wang is the lead Head & Neck surgeon at UCLA and she together with Dr. Marvin Bergsneider perform 100-200 pituitary tumors surgeries annually

Michael Linetsky

Associate Clinical Professor
UCLA

Dr. Michael Linetsky is the radiologist at UCLA and he experts in radiologic diagnosis of pituitary adenoma.

Noriko Salamon

Professor
UCLA

Dr. Noriko Salamon is the radiologist at UCLA and she experts in radiologic diagnosis of pituitary adenoma.

Harry V. Vinters

Professor
UCLA

Dr. Harry V. Vinters is the neuropathologist who's in charge of surgical resected pituitary tumor pathological diagnosis.

Anthony P. Heaney

Professor
UCLA

Anthony P. Heaney, MD, PhD is an Associate Professor at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). His primary areas of clinical and research interest involve the pathogenesis of pituitary tumors and exploiting novel molecular targets to develop innovative treatments for pituitary tumors, and other neuroendocrine tumors.