Upfront Stereotactic Radiosurgery for Nonfunctioning Pituitary Neuroendocrine Tumors: An International, Multicenter...

Area of Science:

• Neurosurgery
• Radiation Oncology
• Endocrinology

Background:

• Nonfunctioning pituitary adenomas (NFPA) pose treatment challenges, especially when surgery is not ideal.
• Upfront stereotactic radiosurgery (SRS) is an emerging option for NFPA management.
• Limited data exists on large-scale outcomes of upfront SRS for NFPA.

Purpose of the Study:

• To evaluate tumor control and complications following single-session SRS in a large, international cohort of untreated NFPA patients.
• To assess the efficacy and safety profile of upfront SRS for NFPA.
• To analyze visual field and cranial nerve outcomes after SRS for NFPA.

Main Methods:

• Multicentric cohort study of 132 untreated NFPA patients.
• Single-session stereotactic radiosurgery (SRS) was administered.
• Tumor control, new pituitary deficits, and visual/neurological outcomes were assessed.

Main Results:

• High tumor control probability: 100% at 3 years, 98.1% at 5 years, and 92.4% at 8 years.
• Cumulative probability of new pituitary deficit at 3, 5, and 8 years was 11.7%, 24.4%, and 29.5%, respectively.
• No new visual field defects occurred; pre-existing deficits showed improvement or stability. Oculomotor nerve palsy outcomes were mostly stable or improved.

Conclusions:

• Upfront SRS is a viable treatment option for carefully selected NFPA patients.
• The procedure demonstrates a favorable efficacy and safety profile.
• Longer follow-up is necessary; visual improvement is limited, emphasizing the need for patient selection.