Kasper Graham, Samuel Nardin, Alkins Ryan, Khan Osaama H
Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 3157, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., WW 4-427 Toronto, ON M5T 2S8, Canada.
eNeurologicalSci. 2021 Jan 22;22:100317. doi: 10.1016/j.ensci.2021.100317. eCollection 2021 Mar.
There is no consensus regarding the management and postoperative follow-up of non-functioning pituitary adenomas (NFAs) in the setting of recurrent or residual disease. Subsequent treatment options include continued follow-up, re-resection or radiotherapy. To address this gap and better understand current practice patterns, we surveyed neurosurgeons and radiation oncologists in Canada.
Neurosurgeons and radiation oncologists (ROs) across Canada were invited to complete a standardized online questionnaire. Summary statistics were computed, and Fisher's Exact tests were performed to assess significance. Qualitative analyses were performed through open and axial coding.
Thirty-three participants completed the questionnaires, with neurosurgeons representing a majority of respondents ( = 20 vs = 13). When treating giant (>3 cm) tumors, 90.9% of neurosurgeons in practice for less than 10 years reported using an endoscopic approach, as compared to only 66.7% of neurosurgeons in practice for 10 years of more. Additionally, neurosurgeons who were newer to practice had a greater tendency to advocate for stereotactic radiosurgery (SRS) or re-resection (54.5% and 36.4%, respectively), as compared to older surgeons who showed a higher propensity (22.2%) to advocate for observation. The presence of cavernous sinus extension appeared to encourage ROs to offer radiotherapy sooner (61.4%), as compared to 40% of neurosurgeons.
Our results identified both variations and commonalities in practice amongst Canadian neurosurgeons. Approaches deviated in the setting of residual tumor based on years of practice. This work provides a critical foundation for future studies aiming to define evidence-based best practices in the management of NFAs.
对于复发性或残留性无功能垂体腺瘤（NFA）的管理和术后随访，目前尚无共识。后续的治疗选择包括继续随访、再次手术切除或放疗。为了填补这一空白并更好地了解当前的实践模式，我们对加拿大的神经外科医生和放射肿瘤学家进行了调查。
邀请加拿大各地的神经外科医生和放射肿瘤学家完成一份标准化的在线问卷。计算了汇总统计数据，并进行了Fisher精确检验以评估显著性。通过开放式编码和轴心式编码进行定性分析。
33名参与者完成了问卷，其中神经外科医生占多数（20名对13名）。在治疗巨大（>3 cm）肿瘤时，从业不到10年的神经外科医生中有90.9%报告使用内镜手术方法，而从业10年及以上的神经外科医生中这一比例仅为66.7%。此外，与经验更丰富的外科医生相比，新入行的神经外科医生更倾向于主张立体定向放射外科（SRS）或再次手术切除（分别为54.5%和36.4%），而经验更丰富的外科医生更倾向于主张观察（22.2%）。海绵窦侵犯的存在似乎促使放射肿瘤学家更早地提供放疗（61.4%），而神经外科医生中这一比例为40%。
我们的结果确定了加拿大神经外科医生在实践中的差异和共性。基于从业年限，在残留肿瘤的处理方法上存在差异。这项工作为未来旨在确定NFA管理中基于证据的最佳实践的研究提供了重要基础。
