TY - JOUR
T1 - Outcome of non-functioning pituitary adenomas that regrow after primary treatment
T2 - a study from two large UK centers
AU - Tampourlou, Metaxia
AU - Ntali, Georgia
AU - Ahmed, Shahzada K
AU - Arlt, Wiebke
AU - Ayuk, John
AU - Byrne, James V
AU - Chavda, Swarupsinh
AU - Cudlip, Simon
AU - Gittoes, Neil
AU - Grossman, Ashley
AU - Mitchell, Rosalind
AU - O'reilly, Michael
AU - Paluzzi, Alessandro
AU - Toogood, Andrew
AU - Wass, John AH
AU - Karavitaki, Niki
PY - 2017/6/1
Y1 - 2017/6/1
N2 - 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.
AB - 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.
U2 - 10.1210/jc.2016-4061
DO - 10.1210/jc.2016-4061
M3 - Article
SN - 0021-972X
VL - 102
SP - 1889
EP - 1897
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 6
ER -