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Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma.
O M Dekkers1, A M Pereira, F Roelfsema
1Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. o.m.dekkers@lumc.nl
The Journal of Clinical Endocrinology and Metabolism
|March 2, 2006
Summary
Transsphenoidal surgery for nonfunctioning pituitary macroadenomas (NFMA) is effective without routine radiotherapy. Most patients experienced no tumor regrowth during the follow-up period, indicating a safe treatment strategy.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Transsphenoidal surgery is the primary treatment for nonfunctioning pituitary macroadenomas (NFMA).
- The necessity of routine postoperative radiotherapy for NFMA remains a subject of investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of transsphenoidal surgery for NFMA when postoperative radiotherapy is not routinely administered.
- To assess tumor regrowth and recurrence rates in patients treated with this strategy.
Main Methods:
- Retrospective follow-up study of 109 consecutive patients operated for NFMA between 1992 and 2004.
- Mean follow-up duration of 6.0 +/- 3.7 years.
- Tumor regrowth or recurrence was assessed via radiological imaging.
Main Results:
- Macroadenomas were present in all patients, with significant suprasellar extension in 96%.
- Postoperative visual field defects improved in 84% of affected patients.
- Tumor regrowth occurred in 9 patients, and recurrence in 1 patient, over the follow-up period. Follow-up duration was a predictor of regrowth.
Conclusions:
- Transsphenoidal surgery alone is an effective and safe treatment for NFMA, with 90% of patients showing no tumor regrowth within the study's follow-up duration.
- Longer follow-up studies are needed to confirm sustained low rates of regrowth and recurrence.