SFEBES2008 Poster Presentations Pituitary (62 abstracts)
The natural history of surgical treated but radiation-naïve non-functioning pituitary adenomas
Eoin O’Sullivan , Conor Woods , Nigel Glynn , LucyAnn Behan , Rachel Crowley , Diarmuid Smith & Amar Agha
Division of Endocrinology and Diabetes, Beaumont Hospital and the RCSI Medical School, Dublin, Ireland.
Studies on the probability of recurrence of surgically treated but radiotherapy (RT) naïve non-functioning pituitary adenomas (NFPA) are inconsistent and selective as cases deemed to be at high risk of recurrence were prophylactically irradiated. We traditionally used very low rate of post-operative RT leaving us with a largely unselected cohort.
We identified 223 surgically resected, histology-proven NFPA cases. Only 9% received post-operative RT and were excluded. The analysis was confined to 165 patients who were followed up in our hospital for over 1 year (median 5.8 years; range 1–45 years). Recurrence was defined as an increase in size of the post-operative tumour remnant on imaging and/or clinical presentation with pressure effect.
About 71% had transsphenoidal and 29% had transcranial surgery. Overall recurrence occurred in 66 cases (40.7%). Multivariate analysis identified the length of follow-up and the size of the post-operative tumour remnant as the risk factors for recurrence. Those with persistent suprasellar lesion were at the highest risk (Table). No other clinical, hormonal, or immunohistochemical features were predictive of recurrence.
In this study, the risk of recurrence of NFPA with significant residual post-operative tumour remnant is very high over time and these patients should be routinely considered for adjuvant radiotherapy.
| Follow-up | <5 years | ≥5 years |
| Number | 72 | 93 |
| Agea | 56 (18–83) | 54 (20–78) |
| Overall Recurrence Recurrence based on post-operative imaging: | 46.2% | 44.4% |
| Empty sella | 80.8% | |
| Persistent intrasellar | ||
| Persistent suprasellar | ||
| Time to recurrence (year)* | 1.8 (0.2–4) | 5.7 (0.2–32.7) |
| aExpressed as median (range). | ||
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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