The University of Southampton
University of Southampton Institutional Repository

Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - A follow-up study

Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - A follow-up study
Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - A follow-up study

OBJECTIVE: Non-functioning pituitary adenomas (NFA) are the commonest type of pituitary macroadenoma. Although the initial definitive management of these tumours is almost always trans-sphenoidal surgery, the use of postoperative radiotherapy remains controversial. Radiotherapy has been shown to significantly reduce the risk of tumour regrowth. An audit of patients with NFAs treated with trans-sphenoidal surgery without irradiation was performed at our centre five years ago, and suggested that careful selection and follow-up could avoid the need for adjuvant radiotherapy. We have repeated this audit to assess the longer term effects of this management strategy. METHODS AND PATIENTS: The case notes and imaging of the original cohort of 65 of 73 patients (50 males, mean age 52) who had undergone transsphenoidal surgery (TSA) for NFA between July 1979 and 1992, had not received irradiation and were followed up by imaging were reviewed. Tumour regrowth was defined as enlargement of the pituitary tumour. Mean follow-up was 76 months (range-12-173). RESULTS: Pituitary tumour regrowth has occurred in 21 of the 65 patients (32%) during a mean follow-up of 76 months compared with 8/73 (11%) in 1994 (P=0.002). The tumour regrowth was detected at a mean of 5-4 years (range 2-14 years). Lifetable analysis of the whole unirradiated group showed 82% recurrence free survival at 5 years (95% confidence limits 72-92%), and 56% at 10 years (95% confidence limits 38-74%). Eight (12%) patients required a second surgical procedure (6 TSA and 2 craniotomies). There was no relationship between recurrence and whether a total surgical removal was thought to have been performed. CONCLUSION: Despite careful selection of patients with non-functioning pituitary adenomas, tumour regrowth occurs in a significant proportion. These results show that continued follow-up in these patients is essential as significantly more patients showed evidence of tumour regrowth at this second assessment corn pared with the 1994 data. Until we are able to predict which tumours are likely to regrow postoperatively, radiotherapy should be considered for all patients with non-functioning pituitary adenomas as even in carefully selected cases, the regrowth rate is approaching 50% at 10 years.

0300-0664
281-284
Turner, H. E.
80522534-96f9-471a-ab78-2904d6547bd4
Stratton, I. M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Byrne, J. V.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Adams, C. B.T.
6144c893-1426-48d9-9f78-816a0c3f72b7
Wass, J. A.H.
ecf5edec-c9f5-403d-b5f1-730ca7147f57
Turner, H. E.
80522534-96f9-471a-ab78-2904d6547bd4
Stratton, I. M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Byrne, J. V.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Adams, C. B.T.
6144c893-1426-48d9-9f78-816a0c3f72b7
Wass, J. A.H.
ecf5edec-c9f5-403d-b5f1-730ca7147f57

Turner, H. E., Stratton, I. M., Byrne, J. V., Adams, C. B.T. and Wass, J. A.H. (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - A follow-up study. Clinical Endocrinology, 51 (3), 281-284. (doi:10.1046/j.1365-2265.1999.00865.x).

Record type: Article

Abstract

OBJECTIVE: Non-functioning pituitary adenomas (NFA) are the commonest type of pituitary macroadenoma. Although the initial definitive management of these tumours is almost always trans-sphenoidal surgery, the use of postoperative radiotherapy remains controversial. Radiotherapy has been shown to significantly reduce the risk of tumour regrowth. An audit of patients with NFAs treated with trans-sphenoidal surgery without irradiation was performed at our centre five years ago, and suggested that careful selection and follow-up could avoid the need for adjuvant radiotherapy. We have repeated this audit to assess the longer term effects of this management strategy. METHODS AND PATIENTS: The case notes and imaging of the original cohort of 65 of 73 patients (50 males, mean age 52) who had undergone transsphenoidal surgery (TSA) for NFA between July 1979 and 1992, had not received irradiation and were followed up by imaging were reviewed. Tumour regrowth was defined as enlargement of the pituitary tumour. Mean follow-up was 76 months (range-12-173). RESULTS: Pituitary tumour regrowth has occurred in 21 of the 65 patients (32%) during a mean follow-up of 76 months compared with 8/73 (11%) in 1994 (P=0.002). The tumour regrowth was detected at a mean of 5-4 years (range 2-14 years). Lifetable analysis of the whole unirradiated group showed 82% recurrence free survival at 5 years (95% confidence limits 72-92%), and 56% at 10 years (95% confidence limits 38-74%). Eight (12%) patients required a second surgical procedure (6 TSA and 2 craniotomies). There was no relationship between recurrence and whether a total surgical removal was thought to have been performed. CONCLUSION: Despite careful selection of patients with non-functioning pituitary adenomas, tumour regrowth occurs in a significant proportion. These results show that continued follow-up in these patients is essential as significantly more patients showed evidence of tumour regrowth at this second assessment corn pared with the 1994 data. Until we are able to predict which tumours are likely to regrow postoperatively, radiotherapy should be considered for all patients with non-functioning pituitary adenomas as even in carefully selected cases, the regrowth rate is approaching 50% at 10 years.

This record has no associated files available for download.

More information

Published date: 1999

Identifiers

Local EPrints ID: 486955
URI: http://eprints.soton.ac.uk/id/eprint/486955
ISSN: 0300-0664
PURE UUID: 78025132-345f-44ed-9895-0f91ab8f2c3b
ORCID for I. M. Stratton: ORCID iD orcid.org/0000-0003-1172-7865

Catalogue record

Date deposited: 08 Feb 2024 17:46
Last modified: 18 Mar 2024 04:01

Export record

Altmetrics

Contributors

Author: H. E. Turner
Author: I. M. Stratton ORCID iD
Author: J. V. Byrne
Author: C. B.T. Adams
Author: J. A.H. Wass

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×