Metastatic pituitary tumors: an institutional case series
Name
11102_2023_1341_ReferencePDF.pdf
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2.64 MB
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Author(s)
Yearley, Alexander G.
Chalif, Eric J.
Gupta, Saksham
Chalif, Joshua I.
Bernstock, Joshua D.
Nawabi, Noah
Arnaout, Omar
Smith, Timothy R.
Reardon, David A.
Laws, Edward R.
Date Issued
July 31, 2023
Publisher
Springer US
Citation
Yearley, Alexander G., Chalif, Eric J., Gupta, Saksham, Chalif, Joshua I., Bernstock, Joshua D. et al. 2023. "Metastatic pituitary tumors: an institutional case series."
Version
Author's final manuscript
Abstract
Abstract
Purpose
Pituitary carcinomas are a rare entity that respond poorly to multimodal therapy. Patients follow a variable disease course that remains ill-defined.
Methods
We present an institutional case series of patients treated for pituitary carcinomas over a 30-year period from 1992 to 2022. A systematic review was conducted to identify prior case series of patients with pituitary carcinomas.
Results
Fourteen patients with a mean age at pituitary carcinoma diagnosis of 52.5 years (standard deviation [SD] 19.4) met inclusion criteria. All 14 patients had tumor subtypes confirmed by immunohistochemistry and hormone testing, with the most common being ACTH-producing pituitary adenomas (n = 12). Patients had a median progression-free survival (PFS) of 1.4 years (range 0.7–10.0) and a median overall survival (OS) of 8.4 years (range 2.3–24.0) from pituitary adenoma diagnosis. Median PFS and OS were 0.6 years (range 0.0-2.2) and 1.5 years (range 0.1–9.6) respectively upon development of metastases. Most patients (n = 12) had locally invasive disease to the cavernous sinus, dorsum sellae dura, or sphenoid sinus prior to metastasis. Common sites of metastasis included the central nervous system, liver, lung, and bone. In a pooled analysis including additional cases from the literature, treatment of metastases with chemotherapy or a combination of radiation therapy and chemotherapy significantly prolonged PFS (p = 0.02), while failing to significantly improve OS (p = 0.14).
Conclusion
Pituitary carcinomas are highly recurrent, heterogenous tumors with variable responses to treatment. Multidisciplinary management with an experienced neuro-endocrine and neuro-oncology team is needed given the unrelenting nature of this disease.
MIT Department
Koch Institute for Integrative Cancer Research at MIT
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DOI of Published Version
https://doi.org/10.1007/s11102-023-01341-4
