Abstract
M.A. de Paiva Neto; A. Vandergrift; N. Fatemi; A.A. Gorgulho; A.A. Desalles; P. Cohan; C. Wang; R. Swerdloff; D.F. Kelly
Objective
Giant
pituitary adenomas (>/=40mm) pose a major management challenge. We describe
the experience of a single surgeon and a dedicated neuro-endocrine team with
multimodality treatment of these tumors in three specialized institutions.
Design: Retrospective dataset analyses.
Patients
Fifty-one
consecutive patients with a giant adenoma (39 endocrine-inactive, 12
endocrine-active; mean tumor diameter 45 mm) treated over 10 years by an
endonasal transsphenoidal approach were included. All patients had surgical
resection followed by radiotherapy and/or medical therapy as judged necessary.
Measurements
Hormonal
and visual status, extent of resection, tumor control rates, complications and
use of medical and radiotherapy were evaluated.
Results
Surgery
resulted in gross total, near total and subtotal removal in 21 (41%), 10 (20%)
and 20 (39%) patients, respectively. Complete tumor removal was associated with
absence of cavernous sinus invasion (p<0.001). Long-term endocrine function
improved in 49% of patients and new endocrinopathy occurred in 14.6%; 76%
required long-term hormone replacement therapy. Vision improved in 81.5%
patients and there was no visual worsening. At last follow-up (median 30
months), tumor control was achieved in 96% of patients: 59% with surgery alone,
20% with surgery plus focused radiotherapy, 18% with surgery and medical
therapy and two with all 3 modalities.
Conclusions
Endonasal
surgery provides effective initial treatment for patients with giant adenomas.
Multi-modality therapy was needed in almost 50% of patients and this rate will
likely increase with longer follow-up. Close collaboration of neurosurgeons
with endocrinologists and radiation oncologists is essential for optimal
treatment of patients with these challenging tumors.