nach oben

Erschienen in:

06.07.2020 | Clinical Study

Stereotactic reirradiation with temozolomide in patients with recurrent aggressive pituitary tumors and pituitary carcinomas

verfasst von: Giuseppe Minniti, Sergio Paolini, Marie Lise Jaffrain Rea, Andrea Isidori, Claudia Scaringi, Ivana Russo, Mattia Falchetto Osti, Luigi Cavallo, Vincenzo Esposito

Erschienen in: Journal of Neuro-Oncology | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To evaluate the efficacy of a second course of fractionated stereotactic radiotherapy (re-SRT) and temozolomide (TMZ) as salvage treatment option in patients with aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs).

Patients and Methods

Twenty-one patients with recurrent or progressive APTs (n = 17) and PCs (n = 4) who received combined TMZ and re-SRT, 36 Gy/18fractions or 37.5 Gy/15fractions, were retrospectively evaluated. TMZ was given at a dose of 75 mg/m² given concurrently to re-SRT, and then 150–200 mg/m²/day for 5 days every 4 weeks or 50 mg/m² daily for 12 months. Local control (LC) and overall survival (OS) were calculated from the time of re-SRT by Kaplan–Meier method.

Results

With a median follow-up of 27 months (range 12–58 months), 2-year and 4-year LC rates were 73% and 65%, respectively; 2-year and 4-year survival rates were 82% and 66%, respectively. A complete response was achieved in 2 and partial response in 11 patients. Six patients recurred with a median time to progression of 14 months. O(6)-Methylguanine-DNA methyltransferase (MGMT) status and tumor volume emerged as prognostic factors. Grade 3 radiation-related toxicities occurred in 3 (14%) patients. Grade 2 or 3 hematologic toxicities during chemotherapy occurred in 8 (38%) patients.

Conclusion

Re-SRT and TMZ is a safe treatment offering high LC in patients with progressive APTs and PCs. The potential advantages of combined chemoradiation as up-front or salvage treatment need to be explored in prospective trials.

Couldwell WT (2004) Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 69:237–256CrossRef

Esposito V, Santoro A, Minniti G, Salvati M, Innocenzi G, Lanzetta G, Cantore G (2004) Transsphenoidal adenomectomy for GH-, PRL- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients. Neurol Sci 25:251–256CrossRef

Little AS, Kelly DF, White WL, Gardner PA, Fernandez-Miranda JC, Chicoine MR, Barkhoudarian G, Chandler JP, Prevedello DM, Liebelt BD, Sfondouris J, Mayberg MR, TRANSSPHER Study Group (2019) Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. J Neurosurg 22:1–11CrossRef

Dai W, Zhuang Z, Ling H, Yang Y, Hang C (2020) Systematic review and network meta-analysis assess the comparative efficacy and safety of transsphenoidal surgery for pituitary tumor. Neurosurg Rev. https://doi.org/10.1007/s10143-020-01240-3CrossRefPubMed

Minniti G, Osti MF, Niyazi M (2016) Target delineation and optimal radiosurgical dose for pituitary tumors. Radiat Oncol 11(1):135CrossRef

Minniti G, Scaringi C, Poggi M, Jaffrain Rea ML, Trillò G, Esposito V, Bozzao A, Enrici MM, Toscano V, Enrici RM (2015) Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response. Eur J Endocrinol 172:433–441CrossRef

Hayhurst C, Taylor PN, Lansdown AJ, Palaniappan N, Rees DA, Davies JS (2020) Current perspectives on recurrent pituitary adenoma: The role and timing of surgery vs adjuvant treatment. Clin Endocrinol (Oxf) 92:89–97CrossRef

Lim S, Shahinian H, Maya MM, Yong W, Heaney AP (2006) Temozolomide: a novel treatment for pituitary carcinoma. Lancet Oncol 7:518–520CrossRef

Raverot G, Sturm N, de Fraipont F, Muller M, Salenave S, Caron P, Chabre O, Chanson P, Cortet-Rudelli C, Assaker R, Dufour H, Gaillard S, François P, Jouanneau E, Passagia JG, Bernier M, Cornélius A, Figarella-Branger D, Trouillas J, Borson-Chazot F, Brue T (2010) Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience. J Clin Endocrinol Metab 95:4592–4599CrossRef

10.

Annamalai AK, Dean AF, Kandasamy N, Kovacs K, Burton H, Halsall DJ, Shaw AS, Antoun NM, Cheow HK, Kirollos RW, Pickard JD, Simpson HL, Jefferies SJ, Burnet NG, Gurnell M (2012) Temozolomide responsiveness in aggressive corticotroph tumours: a case report and review of the literature. Pituitary 15:276–287CrossRef

11.

Whitelaw BC, Dworakowska D, Thomas NW, Barazi S, Riordan-Eva P, King AP, Hampton T, Landau DB, Lipscomb D, Buchanan CR, Gilbert JA, Aylwin SJ (2012) Temozolomide in the management of dopamine agonist-resistant prolactinomas. Clin Endocrinol (Oxf) 76:877–886CrossRef

12.

Bengtsson D, Schrøder HD, Andersen M, Maiter D, Berinder K, Feldt Rasmussen U, Rasmussen ÅK, Johannsson G, Hoybye C, van der Lely AJ, Petersson M, Ragnarsson O, Burman P (2015) Long-term outcome and MGMT as a predictive marker in 24 patients with atypical pituitary adenomas and pituitary carcinomas given treatment with temozolomide. J Clin Endocrinol Metab 100:1689–1698CrossRef

13.

Losa M, Bogazzi F, Cannavo S, Ceccato F, Curtò L, De Marinis L, Iacovazzo D, Lombardi G, Mantovani G, Mazza E, Minniti G, Nizzoli M, Reni M, Scaroni C (2016) Temozolomide therapy in patients with aggressive pituitary adenomas or carcinomas. J Neurooncol 126:519–525CrossRef

14.

Lasolle H, Cortet C, Castinetti F, Cloix L, Caron P, Delemer B, Desailloud R, Jublanc C, Lebrun-Frenay C, Sadoul JL, Taillandier L, Batisse-Lignier M, Bonnet F, Bourcigaux N, Bresson D, Chabre O, Chanson P, Garcia C, Haissaguerre M, Reznik Y, Borot S, Villa C, Vasiljevic A, Gaillard S, Jouanneau E, Assié G, Raverot G (2017) Temozolomide treatment can improve overall survival in aggressive pituitary tumors and pituitary carcinomas. Eur J Endocrinol 176:769–777CrossRef

15.

Jordan JT, Miller JJ, Cushing T, Seijo M, Batchelor TT, Arrillaga-Romany IC, Shih HA, Nachtigall LB, Loeffler JS, Dietrich J (2018) Temozolomide therapy for aggressive functioning pituitary adenomas refractory to surgery and radiation: a case series. Neurooncol Pract 5:64–68PubMed

16.

McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, Burman P, ESE Survey Collaborators (2018) Treatment of aggressive pituitary tumours and carcinomas: results of a European Society of Endocrinology (ESE) survey 2016. Eur J Endocrinol 178:265–276CrossRef

17.

Elbelt U, Schlaffer SM, Buchfelder M, Knappe UJ, Vila G, Micko A, Deutschbein T, Unger N, Lammert A, Topuzoglu-Müller T, Bojunga J, Droste M, Johanssen S, Kolenda H, Ritzel K, Buslei R, Strasburger CJ, Petersenn S, Honegger J (2020) Efficacy of temozolomide therapy in patients with aggressive pituitary adenomas and carcinomas-a german survey. J Clin Endocrinol Metab. https://doi.org/10.1210/clinem/dgz211CrossRef

18.

Wen PY, Weller M, Lee EQ, Alexander BA, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ (2020) Glioblastoma in adults: a society for neuro-oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol. https://doi.org/10.1093/neuonc/noaa106CrossRef

19.

Raverot G, Burman P, McCormack A, Heaney A, Petersenn S, Popovic V, Trouillas J, Dekkers OM, European Society of Endocrinology (2018) European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol 178:G1–G24CrossRef

20.

Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, Asher AL, Loeffler JS, Robinson PD, Andrews DW, Gaspar LE, Kondziolka D, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Patchell RA, Kalkanis SN (2010) The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:85–96CrossRef

21.

Verma J, McCutcheon IE, Waguespack SG, Mahajan A (2014) Feasibility and outcome of re-irradiation in the treatment of multiply recurrent pituitary adenomas. Pituitary 17:539–545CrossRef

22.

Nieder C, Andratschke NH, Grosu AL (2016) Re-irradiation for recurrent primary brain tumors. Anticancer Res 36:4985–4995CrossRef

23.

Kim M, Lee DH, Kim Rn HJ, Cho YH, Kim JH, Kwon DH (2017) Analysis of the results of recurrent intracranial meningiomas treated with re-radiosurgery. Clin Neurol Neurosurg 153:93–101CrossRef

24.

Gupta T, Maitre M, Sastri GJ, Krishnatry R, Shirsat N, Epari S, Sahay A, Chinnaswamy G, Patil V, Shetty P, Moiyadi A (2019) Outcomes of salvage re-irradiation in recurrent medulloblastoma correlate with age at initial diagnosis, primar risk-stratification, and molecular subgrouping. J Neurooncol 144:283–291CrossRef

25.

Navarria P, Minniti G, Clerici E, Tomatis S, Pinzi V, Ciammella P, Galaverni M, Amelio D, Scartoni D, Scoccianti S, Krengli M, Masini L, Draghini L, Maranzano E, Borzillo V, Muto P, Ferrarese F, Fariselli L, Livi L, Pasqualetti F, Fiorentino A, Alongi F, di Monale MB, Magrini S, Scorsetti M (2019) Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO). J Neurooncol 142:59–67CrossRef

26.

Combs SE, Bischof M, Welzel T, Hof H, Oertel S, Debus J, Schulz-Ertner D (2008) Radiochemotherapy with temozolomide as re-irradiation using high precision fractionated stereotactic radiotherapy (FSRT) in patients with recurrent gliomas. J Neurooncol 89:205–210CrossRef

27.

Minniti G, Armosini V, Salvati M, Lanzetta G, Caporello P, Mei M, Osti MF, Maurizi RE (2011) Fractionated stereotactic reirradiation and concurrent temozolomide in patients with recurrent glioblastoma. J Neurooncol 103:683–691CrossRef

28.

Minniti G, Scaringi C, De Sanctis V, Lanzetta G, Falco T, Di Stefano D, Esposito V, Enrici RM (2013) Hypofractionated stereotactic radiotherapy and continuous low-dose temozolomide in patients with recurrent or progressive malignant gliomas. J Neurooncol 111:187–194CrossRef

29.

Minniti G, Salvati M, Arcella A, Buttarelli F, D’Elia A, Lanzetta G, Esposito V, Scarpino S, Maurizi Enrici R, Giangaspero F (2011) Correlation between O6-methylguanine-DNA methyltransferase and survival in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide. J Neurooncol 102:311–316CrossRef

30.

Yamashita S, Yokogami K, Matsumoto F, Saito K, Mizuguchi A, Ohta H, Takeshima H (2018) MGMT promoter methylation in patients with glioblastoma: is methylation-sensitive high-resolution melting superior to methylation-sensitive polymerase chain reaction assay? J Neurosurg 130:780–788CrossRef

31.

Malmström A, Łysiak M, Kristensen BW, Hovey E, Henriksson R, Söderkvist P (2020) Do we really know who has an MGMT methylated glioma? Results of an international survey regarding use of MGMT analyses for glioma. Neurooncol Pract 7:68–76PubMed

32.

van Leeuwen CM, Oei AL, Crezee J, Bel A, Franken NAP, Stalpers LJA, Kok HP (2018) The alfa and beta of tumours: a review of parameters of the linear-quadratic model, derived from clinical radiotherapy studies. Radiat Oncol 13:96CrossRef

33.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRef

34.

Kong DS, Lee JI, Kim JH, Kim ST, Kim WS, Suh YL, Dong SM, Nam DH (2010) Phase II trial of low-dose continuous (metronomic) treatment of temozolomide for recurrent glioblastoma. Neuro Oncol 12:289–296CrossRef

35.

Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF (2010) Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol 28:2051–2057CrossRef

36.

Osamura RY, Grossman A, Korbonits M, Kovacs K, Lopes MBS, Matsuno A, Trouillas J (2017) WHO classification of tumours of endocrine organs. In: Pituitary adenoma. Chapter 1: tumors of the pituitary gland. WHO, Lyon, pp 14–18

37.

Chang EF, Sughrue ME, Zada G, Wilson CB, Blevins LS Jr, Kunwar S (2010) Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 13:223–229CrossRef

38.

Priola SM, Esposito F, Cannavò S, Conti A, Abbritti RV, Barresi V, Baldari S, Ferraù F, Germanò A, Tomasello F, Angileri FF (2017) Aggressive pituitary adenomas: the dark side of the moon. World Neurosurg 97:140–155CrossRef

39.

Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122CrossRef

40.

Lawrence YR (2010) Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 76(3 Suppl):S20–S27CrossRef

41.

Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76(3 Suppl):S10–S19CrossRef

42.

Mayo C, Martel MK, Marks LB, Flickinger J, Nam J, Kirkpatrick J (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 76(3 Suppl):S28–S35CrossRef

43.

Mayer R, Sminia P (2008) Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 70:1350–1360CrossRef

Titel: Stereotactic reirradiation with temozolomide in patients with recurrent aggressive pituitary tumors and pituitary carcinomas
verfasst von: Giuseppe Minniti
Sergio Paolini
Marie Lise Jaffrain Rea
Andrea Isidori
Claudia Scaringi
Ivana Russo
Mattia Falchetto Osti
Luigi Cavallo
Vincenzo Esposito
Publikationsdatum: 06.07.2020
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 1/2020
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-020-03579-5

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Thrombektomie auch bei großen Infarkten von Vorteil

16.05.2024 Ischämischer Schlaganfall Nachrichten

Auch ein sehr ausgedehnter ischämischer Schlaganfall scheint an sich kein Grund zu sein, von einer mechanischen Thrombektomie abzusehen. Dafür spricht die LASTE-Studie, an der Patienten und Patientinnen mit einem ASPECTS von maximal 5 beteiligt waren.

Schwindelursache: Massagepistole lässt Otholiten tanzen

14.05.2024 Benigner Lagerungsschwindel Nachrichten

Wenn jüngere Menschen über ständig rezidivierenden Lagerungsschwindel klagen, könnte eine Massagepistole der Auslöser sein. In JAMA Otolaryngology warnt ein Team vor der Anwendung hochpotenter Geräte im Bereich des Nackens.

Schützt Olivenöl vor dem Tod durch Demenz?

10.05.2024 Morbus Alzheimer Nachrichten

Konsumieren Menschen täglich 7 Gramm Olivenöl, ist ihr Risiko, an einer Demenz zu sterben, um mehr als ein Viertel reduziert – und dies weitgehend unabhängig von ihrer sonstigen Ernährung. Dafür sprechen Auswertungen zweier großer US-Studien.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Objectives

Patients and Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2020

Autoimmune disease-related primary CNS lymphoma: systematic review and meta-analysis

Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma

Repolarization of tumor infiltrating macrophages and increased survival in mouse primary CNS lymphomas after XPO1 and BTK inhibition

Pontine gliomas a 10-year population-based study: a report from The Canadian Paediatric Brain Tumour Consortium (CPBTC)

Temozolomide and seizure outcomes in a randomized clinical trial of elderly glioblastoma patients