[en] [en] OBJECTIVE: The management of giant pituitary tumors is complex, with few publications and recommendations. Consequently, patient's care mainly relies on clinical experience. We report here a first large series of patients with giant pituitary tumors managed by a multidisciplinary expert team, focusing on treatments and outcome.
METHODS: A retrospective cohort study was conducted. Giant pituitary tumors were defined by a main diameter > 40mm. Macroprolactinomas sensitive to dopamine agonists were excluded. All patients were operated by a single neurosurgical team. After surgery, multimodal management was proposed, including hormone replacement, radiotherapy and anti-tumor medical therapies. Outcome was modeled using Kaplan-Meyer representation. A logistic regression model was built to identify the risk factors associated with surgical complications.
RESULTS: 63 consecutive patients presented a giant adenoma, most often with visual defects. Patients were operated once, twice or three times in 59%, 40% and 1% of cases respectively, mainly through endoscopic endonasal approach. Giant adenomas included gonadotroph, corticotroph, somatotroph, lactotroph and mixed GH-PRL subtypes in 67%, 14%, 11%, 6% and 2% of patients respectively. Vision improved in 89% of patients with prior visual defects. Severe surgical complications occurred in 11% of patients, mainly for tumors > 50 mm requiring microscopic transcranial approach. Additional radiotherapy was needed for 29% of patients, 3 to 56 months after first surgery. For 6% of patients, Temozolomide treatment was required, 19 to 66 months after first surgery.
CONCLUSIONS: Giant pituitary tumors require multimodal management, with a central role of surgery. Most often, tumor control can be achieved by expert multidisciplinary teams.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Gaillard, Stephan; Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
Adeniran, Sosthène; Department of Neurosurgery, Centre Hospitalier Universitaire Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina Faso
Villa, Chiara ; Université de Liège - ULiège > Département des sciences cliniques > Endocrinologie ; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France ; Department of Pathological Cytology and Anatomy, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
Jouinot, Anne; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France ; Institut Curie, INSERM, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
Raffin-Sanson, Marie-Laure; Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France ; Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France
Feuvret, Loic; Radiation Oncology Department, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpétrière University Hospital, Paris, France
Verrelle, Pierre; Radiation Oncology Department, Institut Curie, Paris, France
Bonnet, Fidéline; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France ; Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Hormonal Biology Laboratory, Paris, France
Dohan, Anthony; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
Bertherat, Jérôme; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France ; Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Center for Rare Adrenal Diseases, Paris, France
Assié, Guillaume; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France ; Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Center for Rare Adrenal Diseases, Paris, France
Baussart, Bertrand; Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France ; Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France
Language :
English
Title :
Outcome of giant pituitary tumors requiring surgery.
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