Outcome of nonfunctioning pituitary adenomas that regrow after primary treatment: a study from two large UK centers
Author(s)
Type
Journal Article
Abstract
Context:
Despite the major risk of regrowth of clinically nonfunctioning pituitary adenomas (CNFAs) after primary treatment, systematic data on the probability of further tumor progression and the effectiveness of management approaches are lacking.
Objective:
To assess the probability of further regrowth(s), predictive factors, and outcomes of management approaches in patients with CNFA diagnosed with adenoma regrowth after primary treatment.
Patients, Design, and Setting:
Retrospective cohort study of 237 patients with regrown CNFA managed in two UK centers.
Results:
Median follow-up was 5.9 years (range, 0.4 to 37.7 years). The 5-year second regrowth rate was 35.3% (36.2% after surgery; 12.5% after radiotherapy; 12.7% after surgery combined with radiotherapy; 63.4% with monitoring). Of those managed with monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for second regrowth. Among those with second adenoma regrowth, the 5-year third regrowth rate was 26.4% (24.4% after surgery; 0% after radiotherapy; 0% after surgery combined with radiotherapy; 48.3% with monitoring). Overall, patients with a CNFA regrowth had a 4.4% probability of a third regrowth at 5 years and a 10.0% probability at 10 years; type of management of the first regrowth was the only risk factor. Malignant transformation was diagnosed in two patients.
Conclusions:
Patients with regrown CNFA after primary treatment continue to carry considerable risk of tumor progression, necessitating long-term follow-up. Management approach to the regrowth was the major factor determining this risk; monitoring had >60% risk of progression at 5 years, and a substantial number of patients ultimately required intervention.
Despite the major risk of regrowth of clinically nonfunctioning pituitary adenomas (CNFAs) after primary treatment, systematic data on the probability of further tumor progression and the effectiveness of management approaches are lacking.
Objective:
To assess the probability of further regrowth(s), predictive factors, and outcomes of management approaches in patients with CNFA diagnosed with adenoma regrowth after primary treatment.
Patients, Design, and Setting:
Retrospective cohort study of 237 patients with regrown CNFA managed in two UK centers.
Results:
Median follow-up was 5.9 years (range, 0.4 to 37.7 years). The 5-year second regrowth rate was 35.3% (36.2% after surgery; 12.5% after radiotherapy; 12.7% after surgery combined with radiotherapy; 63.4% with monitoring). Of those managed with monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for second regrowth. Among those with second adenoma regrowth, the 5-year third regrowth rate was 26.4% (24.4% after surgery; 0% after radiotherapy; 0% after surgery combined with radiotherapy; 48.3% with monitoring). Overall, patients with a CNFA regrowth had a 4.4% probability of a third regrowth at 5 years and a 10.0% probability at 10 years; type of management of the first regrowth was the only risk factor. Malignant transformation was diagnosed in two patients.
Conclusions:
Patients with regrown CNFA after primary treatment continue to carry considerable risk of tumor progression, necessitating long-term follow-up. Management approach to the regrowth was the major factor determining this risk; monitoring had >60% risk of progression at 5 years, and a substantial number of patients ultimately required intervention.
Date Issued
2017-06-01
Date Acceptance
2017-02-27
Citation
Journal of Clinical Endocrinology and Metabolism (JCEM), 2017, 102 (6), pp.1889-1897
ISSN
0021-972X
Publisher
Oxford University Press
Start Page
1889
End Page
1897
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
Volume
102
Issue
6
Copyright Statement
Copyright © 2017 Endocrine Society.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/28323946
PII: 3060518
Subjects
COMPLICATIONS
Endocrinology & Metabolism
FOLLOW-UP
Life Sciences & Biomedicine
METAANALYSIS
PREVALENCE
RADIOSURGERY
Science & Technology
SILENT CORTICOTROPH ADENOMAS
STEREOTACTIC RADIOTHERAPY
SURGERY
TUMORS
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2017-03-02