Abou-Al-Shaar Hussam, Albalkhi Ibrahem, Shariff Rimsha K, Mallela Arka N, Fazeli Pouneh K, Tos Salem M, Mantziaris Georgios, Meng Ying, Bernstein Kenneth, Kaisman-Elbaz Tehila, Abofani Hanan, Lin Yen-Yu, Lee Cheng-Chia, Tripathi Manjul, Upadhyay Rituraj, Palmer Joshua D, Nabeel Ahmed M, Reda Wael A, Tawadros Sameh R, Abdelkarim Khaled, El-Shehaby Amr M N, Emad Reem M, Peker Selcuk, Samanci Yavuz, Wegner Rodney E, Shepard Matthew J, Liscak Roman, Simonova Gabriela, Almeida Timoteo, Benjamin Carolina, Kondziolka Douglas, Sheehan Jason P, Niranjan Ajay, Hadjipanayis Constantinos G, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Endocrinology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pituitary. 2025 May 29;28(3):69. doi: 10.1007/s11102-025-01542-z.
Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort.
The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications.
Among 63 patients included in the study (median tumor volume: 1.5 cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10 Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63).
SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.
垂体转移瘤（PM）占所有颅内转移瘤的0.4%，通常表现为视觉和内分泌功能障碍。立体定向放射外科（SRS）在颅内转移瘤的治疗中已显示出良好的肿瘤控制效果和安全性。然而，其在垂体转移瘤治疗中的作用和安全性尚未得到充分阐明。本研究旨在评估多中心国际队列中SRS治疗PM的疗效和安全性。
作者回顾性分析了来自12家机构的63例接受SRS治疗的PM患者的数据，评估临床和影像学结果，包括生存率、肿瘤控制、视觉和内分泌结果以及治疗后并发症。
在纳入研究的63例患者中（肿瘤体积中位数：1.5 cc），SRS在12个月时的局部肿瘤控制率为93.1%。中位生存期为25.4个月，6个月、12个月和18个月时的总生存率分别为77.6%、65.9%和55.1%。多因素分析显示，PM的边缘剂量>10 Gy是无进展生存期（HR：0.20，p<0.01）、无远处转移生存期（HR：0.30，p=0.01）和总生存期（HR：0.15，p<0.01）的独立预测因素。SRS治疗后，大多数患者的视觉功能保持稳定或改善（n=17/18）。一小部分患者出现并发症：出现新的视觉功能障碍（n=1/63）、出现新的垂体前叶激素缺乏（n=5/63）以及治疗后出现精氨酸加压素（AVP）缺乏（n=2/63）。
SRS是PM治疗中的一种重要方式，具有良好的局部肿瘤控制效果和生存结果，且发病率极低。这些发现支持将SRS纳入PM患者的多学科治疗中。
