Contemporary Treatment Outcome of Metastases to the Pituitary Gland

Sukwoo Hong; John L Atkinson; Dana Erickson; Sani H Kizilbash; Jason T Little; David M Routman; Jamie J Van Gompel

doi:10.1016/j.wneu.2023.02.002

Contemporary Treatment Outcome of Metastases to the Pituitary Gland

World Neurosurg. 2023 Apr:172:e684-e694. doi: 10.1016/j.wneu.2023.02.002. Epub 2023 Feb 9.

Authors

Sukwoo Hong¹, John L Atkinson¹, Dana Erickson², Sani H Kizilbash³, Jason T Little⁴, David M Routman⁵, Jamie J Van Gompel⁶

Affiliations

¹ Departments of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
² Departments of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
³ Departments of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Departments of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Departments of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Departments of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Departments of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: vangompel.jamie@mayo.edu.

PMID: 36764447
DOI: 10.1016/j.wneu.2023.02.002

Abstract

Objective: Metastasis to the pituitary gland is uncommon. With life expectancy after cancer diagnosis improving, we sought to understand the effects of treating pituitary metastasis in the modern era of advanced cancer treatment.

Methods: Patients who had been diagnosed with, and treated for, pituitary metastasis from 2000 to 2021 were retrospectively analyzed.

Results: A total of 48 patients were identified, of whom 23 (48%) were women. The most common primary cancer was the lung (n = 23; 48%), followed by the breast (n = 9; 19%). Of the 48 patients, 29 (60%) had had hypopituitarism and 12 (25%), visual field deficits. Twenty-seven patients (56%) had had solitary pituitary metastasis, with no evidence of other intracranial metastatic lesions. Of the 48 patients, 14 (29%) had undergone surgery and 20 (42%) had undergone standalone radiation therapy (preceded by biopsy for 3). After surgery and/or radiation therapy, the visual field deficits had improved in 6 patients, hypopituitarism had improved in 4 patients, and hypopituitarism had occurred in 3 patients. The median overall survival (OS) was 12 months (interquartile range, 3.0-28 months). Multivariate analysis showed nonsolitary pituitary metastasis (hazard ratio, 2.8; 95% confidence interval, 1.5-5.5; P = 0.0021) and no surgery or radiation therapy (hazard ratio, 2.08; 95% confidence interval, 1.04-4.15; P = 0.038) were associated with OS. For those with solitary pituitary metastasis, the patients who had undergone surgery and/or radiation therapy had had better 1-year OS than patients who had not received either (P = 0.03). In contrast, for patients with nonsolitary pituitary metastasis, those who had undergone standalone radiation therapy had had better 1-year OS than the patients who had not received either (P = 0.03).

Conclusions: In the selected population, metastasis-directed therapy was associated with improved OS. Either correct patient selection for additional therapy or surgery and/or radiation therapy directly benefited patients' OS.

Keywords: Endoscopic; Metastases; Pituitary metastasis; Radiation; Surgery.

MeSH terms

Female
Humans
Hypopituitarism* / etiology
Male
Pituitary Gland
Pituitary Neoplasms* / radiotherapy
Pituitary Neoplasms* / surgery
Retrospective Studies
Treatment Outcome