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Prognostic significance of corticotroph staining in radiosurgery for non-functioning pituitary adenomas: a multicenter study

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Abstract

Silent corticotroph staining pituitary adenoma (SCA) represents an uncommon subset of Non-Functioning adenomas (NFAs), hypothesized to be more locally aggressive. In this retrospective multicenter study, we investigate the safety and effectiveness of Stereotactic Radiosurgery (SRS) in patients with SCA compared with other non-SCA NFA’s. Eight centers participating in the International Gamma-Knife Research Foundation (IGKRF) contributed to this study. Outcomes of 50 patients with confirmed SCAs and 307 patients with confirmed non-SCA NFA’s treated with SRS were evaluated. Groups were matched. SCA was characterized by a lack of clinical evidence of Cushing disease, yet with positive immunostaining for corticotroph. Median age was 55.2 years (13.7–87). All patients underwent at least one trans-sphenoidal tumor resection prior to SRS. SRS parameters were comparable as well. Median follow-up 40 months (6-163). Overall tumor control rate (TCR) 91.2% (n = 280). In the SCA group, TCR were 82% (n = 41) versus 94.1% (n = 289) for the control-NFA (p = 0.0065). The SCA group showed a significantly higher incidence of new post-SRS visual deficit (p < 0.0001) assigned to tumor progression and growth, and post-SRS weakness and fatigue (p < 0.0001). In univariate and multivariate analysis, only the status of silent corticotroph staining (p = 0.005, p = 0.009 respectively) and margin dose (p < 0.0005, p = 0.0037 respectively) significantly influenced progression rate. A margin dose of ≥17 Gy was noted to influence the adenoma progression rate in the entire cohort (p = 0.003). Silent corticotroph staining represents an independent factor for adenoma progression and hypopituitarism after SRS. A higher margin dose may convey a greater chance of TCR.

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Funding

This study was completely independently founded. We state that no personal or institutional financial interest exists for drugs, materials, or devices described in our submission.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Or Cohen-Inbar, Zhiyuan Xu & Jason P. Sheehan

  2. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, Republic of China

    Cheng-chia Lee

  3. National Yang-Ming University, Taipei, Taiwan, Republic of China

    Cheng-chia Lee

  4. Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan, Republic of China

    Chin-Chun Wu

  5. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    Tomáš Chytka

  6. Rose-Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Danilo Silva, Mayur Sharma & Hesham Radwan

  7. Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA

    Inga S. Grills, Brandon Nguyen & Zaid Siddiqui

  8. Department of Neurosurgery, Centre de Recherche Clinique Étienne-LeBel, University of Sherbrooke, Sherbrooke, QC, Canada

    David Mathieu & Christian Iorio-Morin

  9. Department of Neurosurgery, New York University Langone Medical Center, New York, NY, USA

    Amparo Wolf & Douglas Kondziolka

  10. Department of Neurosurgery, West Virginia University, Morgantown, WV, USA

    Christopher P. Cifarelli

  11. Department of Anesthesiology, West Virginia University, Morgantown, WV, USA

    Daniel T. Cifarelli

  12. Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA

    L. Dade Lunsford

  13. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA

    Or Cohen-Inbar

Authors
  1. Or Cohen-Inbar
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  2. Zhiyuan Xu
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  3. Cheng-chia Lee
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  4. Chin-Chun Wu
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  5. Tomáš Chytka
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  6. Danilo Silva
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  7. Mayur Sharma
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  8. Hesham Radwan
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  9. Inga S. Grills
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  10. Brandon Nguyen
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  11. Zaid Siddiqui
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  12. David Mathieu
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  13. Christian Iorio-Morin
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  14. Amparo Wolf
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  15. Christopher P. Cifarelli
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  16. Daniel T. Cifarelli
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  17. L. Dade Lunsford
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  18. Douglas Kondziolka
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  19. Jason P. Sheehan
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Corresponding author

Correspondence to Or Cohen-Inbar.

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Disclosure

Dr. Inga S. Grills has stock ownership and serve on the Board of Directors in a company called Greater Michigan Gamma Knife. In addition, Dr. Lunsford is a shareholder and consultant for Elekta AB.

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Cohen-Inbar, O., Xu, Z., Lee, Cc. et al. Prognostic significance of corticotroph staining in radiosurgery for non-functioning pituitary adenomas: a multicenter study. J Neurooncol 135, 67–74 (2017). https://doi.org/10.1007/s11060-017-2520-y

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  • DOI: https://doi.org/10.1007/s11060-017-2520-y

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