Bioletto Fabio, Bogeat Caroline, Barat Maxime, Benanteur Nesrine, Guignat Laurence, Hage Mirella, Garcia Cyril, Calugaru Valentin, Jacob Julian, Arrondeau Jennifer, Groussin Lionel, Bertagna Xavier, Bertherat Jérôme, Villa Chiara, Jouinot Anne, Baussart Bertrand, Assié Guillaume
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, 75014 Paris, France.
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Eur J Endocrinol. 2025 Jun 30;193(1):167-178. doi: 10.1093/ejendo/lvaf136.
Radiotherapy plays a relevant role in uncontrolled pituitary neuroendocrine tumors (PitNETs). Radiotherapy controls tumor progression in most cases, but not always. Prognostic factors for tumor progression after radiotherapy remain poorly defined. The aim was to evaluate tumor progression after radiotherapy, to identify risk factors, and to report management and outcomes in a cohort of PitNETs with uncontrolled progression.
This was a retrospective, single-center, observational study.
In total, 123 consecutive patients who underwent radiotherapy for PitNETs and were followed at Cochin Hospital between 2000 and 2022 were included. Indication for radiotherapy was uncontrolled tumor progression (80%), adjuvant (9%), or uncontrolled secretion (11%). The median follow-up after radiotherapy was 10.0 years.
Tumor progression after radiotherapy was observed in 28/123 (23%) patients. Higher risk of progression was associated with lactotroph and corticotroph tumor types (HR [95% CI] 12.0 [1.2-117.1] and 9.3 [1.3-69.6], respectively), male sex (3.7 [1.6-8.4]), and necrotic-hemorrhagic changes before radiotherapy on magnetic resonance imaging (3.1 [1.1-8.4]). Surgery, temozolomide, and re-irradiation were the most frequent treatments for the management of patients with tumor progression after radiotherapy, used in 18/28(64%), 16/28(57%), and 8/28(29%) cases, respectively. The most common complication of radiotherapy was the new onset of pituitary deficits, observed in 41% of cases; other complications, including radiation-induced neuroinflammation, cerebrovascular events, and second brain tumors, were rare. Three patients developed metastases, and 6 patients died because of tumor progression.
Lactotroph and corticotroph PitNETs, in male patients, and/or with necrotic-hemorrhagic changes are at higher risk of progression after radiotherapy. Patients with progression after radiotherapy require additional heavy treatments with variable outcome.
放射治疗在无法控制的垂体神经内分泌肿瘤（PitNETs）中发挥着重要作用。放射治疗在大多数情况下可控制肿瘤进展，但并非总是如此。放射治疗后肿瘤进展的预后因素仍不明确。本研究旨在评估放射治疗后的肿瘤进展情况，确定危险因素，并报告一组进展无法控制的PitNETs患者的治疗及结局。
这是一项回顾性、单中心观察性研究。
共纳入2000年至2022年期间在科钦医院接受PitNETs放射治疗并接受随访的123例连续患者。放射治疗的指征为肿瘤进展无法控制（80%）、辅助治疗（9%）或分泌无法控制（11%）。放射治疗后的中位随访时间为10.0年。
123例患者中有28例（23%）在放射治疗后出现肿瘤进展。进展风险较高与催乳素瘤和促肾上腺皮质激素瘤类型相关（风险比[95%置信区间]分别为12.0[1.2 - 117.1]和9.3[1.3 - 69.6]）、男性（3.7[1.6 - 8.4]）以及放射治疗前磁共振成像显示的坏死出血性改变（3.1[1.1 - 8.4]）。手术、替莫唑胺和再次放射治疗是放射治疗后肿瘤进展患者最常用的治疗方法，分别用于18/28（64%）、16/28（57%）和8/28（29%）的病例。放射治疗最常见的并发症是垂体功能减退新发，41%的病例出现该情况；其他并发症，包括放射性神经炎症、脑血管事件和继发性脑肿瘤，较为罕见。3例患者发生转移，6例患者因肿瘤进展死亡。
催乳素瘤和促肾上腺皮质激素瘤PitNETs、男性患者以及/或有坏死出血性改变的患者在放射治疗后进展风险较高。放射治疗后进展的患者需要额外的强化治疗，结局各异。
