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Current status and treatment modalities in metastases to the pituitary: a systematic review

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Abstract

Background

Metastases to the pituitary (MP) are uncommon, accounting for 0.4% of intracranial metastases. Through advances in neuroimaging and oncological therapies, patients with metastatic cancers are living longer and MP may be more frequent. This review aimed to investigate clinical and oncological features, treatment modalities and their effect on survival.

Methods

A systematic review was performed according to PRISMA recommendations. All cases of MP were included, excepted primary pituitary neoplasms and autopsy reports. Descriptive and survival analyses were then conducted.

Results

The search identified 2143 records, of which 157 were included. A total of 657 cases of MP were reported, including 334 females (50.8%). The mean ± standard deviation age was 59.1 ± 11.9 years. Lung cancer was the most frequent primary site (31.0%), followed by breast (26.2%) and kidney cancers (8.1%). Median survival from MP diagnosis was 14 months. Overall survival was significantly different between lung, breast and kidney cancers (P < .0001). Survival was impacted by radiotherapy (hazard ratio (HR) 0.49; 95% confidence interval (CI) 0.35–0.67; P < .0001) and chemotherapy (HR 0.58; 95% CI 0.36–0.92; P = .013) but not by surgery. Stereotactic radiotherapy tended to improve survival over conventional radiotherapy (HR 0.66; 95% CI 0.39–1.12; P = .065). Patients from recent studies (≥ 2010) had longer survival than others (HR 1.36; 95% CI 1.05–1.76; P = .0019).

Conclusion

This systematic review based on 657 cases helped to better identify clinical features, oncological characteristics and the effect of current therapies in patients with MP. Survival patterns were conditioned upon primary cancer histologies, the use of local radiotherapy and systemic chemotherapy, but not by surgery.

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References

  1. Habu M, Tokimura H, Hirano H et al (2015) Pituitary metastases: current practice in Japan. J Neurosurg 123:998–1007. https://doi.org/10.3171/2014.12.JNS14870

    Article  CAS  PubMed  Google Scholar 

  2. Fassett DR, Couldwell WT (2004) Metastases to the pituitary gland. Neurosurg Focus 16:E8

    Article  PubMed  Google Scholar 

  3. He W, Chen F, Dalm B et al (2015) Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis. Pituitary 18:159–168. https://doi.org/10.1007/s11102-014-0552-2

    Article  PubMed  Google Scholar 

  4. Freda PU, Post KD (1999) Differential diagnosis of sellar masses. Endocrinol Metab Clin N Am 28:81–117. https://doi.org/10.1016/S0889-8529(05)70058-X

    Article  CAS  Google Scholar 

  5. Nelson PB, Robinson AG, Martinez JA (1987) Metastatic tumor of the pituitary gland. Neurosurgery 21:941–944. https://doi.org/10.1227/00006123-198712000-00030

    Article  CAS  PubMed  Google Scholar 

  6. Heshmati HM, Scheithauer BW, Young WF (2002) Metastases to the pituitary gland. Endocrinologist 12:45–49. https://doi.org/10.1097/00019616-200201000-00010

    Article  Google Scholar 

  7. Zhao Y, Lian W, Xing B et al (2018) Diagnosis, therapy, and therapeutic effects in cases of pituitary metastasis. World Neurosurg 117:122–128. https://doi.org/10.1016/j.wneu.2018.05.205

    Article  PubMed  Google Scholar 

  8. Komninos J, Vlassopoulou V, Protopapa D et al (2004) Tumors metastatic to the pituitary gland: case report and literature review. J Clin Endocrinol Metab 89:574–580. https://doi.org/10.1210/jc.2003-030395

    Article  CAS  PubMed  Google Scholar 

  9. Morita A, Meyer FB, Laws ER (1998) Symptomatic pituitary metastases. J Neurosurg 89:69–73. https://doi.org/10.3171/jns.1998.89.1.0069

    Article  CAS  PubMed  Google Scholar 

  10. Iwai Y, Yamanaka K, Honda Y, Matsusaka Y (2004) Radiosurgery for pituitary metastases. Neurol Med Chir 44:112–117. https://doi.org/10.2176/nmc.44.112

    Article  Google Scholar 

  11. Kano H, Niranjan A, Kondziolka D et al (2009) Stereotactic radiosurgery for pituitary metastases. Surg Neurol 72:248–255. https://doi.org/10.1016/j.surneu.2008.06.003

    Article  PubMed  Google Scholar 

  12. Chon H, Yoon K, Kwon DH et al (2017) Hypofractionated stereotactic radiosurgery for pituitary metastases. J Neurooncol 132:127–133. https://doi.org/10.1007/s11060-016-2346-z

    Article  PubMed  Google Scholar 

  13. Di Nunno V, Mollica V, Corcioni B et al (2018) Clinical management of a pituitary gland metastasis from clear cell renal cell carcinoma. Anticancer Drugs 29:710–715. https://doi.org/10.1097/CAD.0000000000000644

    Article  CAS  PubMed  Google Scholar 

  14. Priddy B, Hardesty DA, Beer-Furlan A et al (2017) Cerebrospinal fluid leak rhinorrhea after systemic erlotinib chemotherapy for metastatic lung cancer: a familiar problem from an unfamiliar culprit. World Neurosurg 108:992.e11–992.e14. https://doi.org/10.1016/j.wneu.2017.08.183

    Article  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  16. Duchen LW (1966) Metastatic carcinoma in the pituitary gland and hypothalamus. J Pathol Bacteriol 91:347–355. https://doi.org/10.1002/path.1700910208

    Article  CAS  PubMed  Google Scholar 

  17. Gsponer J, Tribolet ND, Déruaz J-P et al (1999) Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses: retrospective analysis of 353 patients. Medicine 78:236–269. https://doi.org/10.1097/00005792-199907000-00004

    Article  CAS  PubMed  Google Scholar 

  18. Max MB, Deck MDF, Rottenberg DA (1981) Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenorna. Neurology 31:998–998. https://doi.org/10.1212/WNL.31.8.998

    Article  CAS  PubMed  Google Scholar 

  19. Houck WA, Olson KB, Horton J (1970) Clinical features of tumor metastasis to the pituitary. Cancer 26:656–659. https://doi.org/10.1002/1097-0142(197009)26:3%3c656:aid-cncr2820260325%3e3.0.co;2-m

    Article  CAS  PubMed  Google Scholar 

  20. Sioutos P, Yen V, Arbit E (1996) Pituitary gland metastases. Ann Surg Oncol 3:94–99. https://doi.org/10.1007/BF02409058

    Article  CAS  PubMed  Google Scholar 

  21. Kimmel DW, O’Neill BP (1983) Systemic cancer presenting as diabetes insipidus. Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus. Cancer 52:2355–2358. https://doi.org/10.1002/1097-0142(19831215)52:12%3c2355:aid-cncr2820521232%3e3.0.co;2-j

    Article  CAS  PubMed  Google Scholar 

  22. Al-Aridi R, El Sibai K, Fu P et al (2014) Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review. Pituitary 17:575–587. https://doi.org/10.1007/s11102-013-0542-9

    Article  CAS  PubMed  Google Scholar 

  23. Schill F, Nilsson M, Olsson DS et al (2019) Pituitary metastases: a nationwide study on current characteristics with special reference to breast cancer. J Clin Endocrinol Metab 104:3379–3388. https://doi.org/10.1210/jc.2019-00012

    Article  PubMed  Google Scholar 

  24. Arafah BM, Nasrallah MP (2001) Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr Relat Cancer 8:287–305

    Article  CAS  PubMed  Google Scholar 

  25. Sathananthan M, Sathananthan A, Scheithauer BW et al (2013) Sellar meningiomas: an endocrinologic perspective. Pituitary 16:182–188. https://doi.org/10.1007/s11102-012-0399-3

    Article  PubMed  Google Scholar 

  26. Byun DJ, Wolchok JD, Rosenberg LM, Girotra M (2017) Cancer immunotherapy—immune checkpoint blockade and associated endocrinopathies. Nat Rev Endocrinol 13:195–207. https://doi.org/10.1038/nrendo.2016.205

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Joshi MN, Whitelaw BC, Palomar MTP et al (2016) Immune checkpoint inhibitor-related hypophysitis and endocrine dysfunction: clinical review. Clin Endocrinol 85:331–339. https://doi.org/10.1111/cen.13063

    Article  CAS  Google Scholar 

  28. Zoli M, Mazzatenta D, Faustini-Fustini M et al (2013) Pituitary metastases: role of surgery. World Neurosurg 79:327–330. https://doi.org/10.1016/j.wneu.2012.03.018

    Article  PubMed  Google Scholar 

  29. Feiz-Erfan I, Rao G, White W, McCutcheon I (2008) Efficacy of trans-septal trans-sphenoidal surgery in correcting visual symptoms caused by hematogenous metastases to the sella and pituitary gland. Skull Base 18:077–084. https://doi.org/10.1055/s-2007-991105

    Article  Google Scholar 

  30. Shen Z, Yang C, Bao X, Wang R (2018) Giant sellar metastasis from renal cell carcinoma: a case report and literature review. Medicine 97:e13376. https://doi.org/10.1097/MD.0000000000013376

    Article  PubMed  PubMed Central  Google Scholar 

  31. Payandeh M, Sadeghi M, Sadeghi E (2016) The complete response to targeted drugs without surgery or radiotherapy: a case of pituitary metastasis from renal cell carcinoma. Acta Med Iran 54:617–619

    PubMed  Google Scholar 

  32. Wendel C, Campitiello M, Plastino F, et al. (2017) Pituitary metastasis from renal cell carcinoma: description of a case report. Am J Case Rep 18:7–11. https://doi.org/10.12659/ajcr.901032

    Article  Google Scholar 

  33. Castle-Kirszbaum M, Goldschlager T, Ho B et al (2018) Twelve cases of pituitary metastasis: a case series and review of the literature. Pituitary 21:463–473. https://doi.org/10.1007/s11102-018-0899-x

    Article  PubMed  Google Scholar 

  34. Gilard V, Alexandru C, Proust F et al (2016) Pituitary metastasis: is there still a place for neurosurgical treatment? J Neurooncol 126:219–224. https://doi.org/10.1007/s11060-015-1967-y

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, 34 295, Montpellier Cedex 5, France

    Sam Ng

  2. Department of Skull Base and Pituitary Surgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France

    Franklin Fomekong, Violaine Delabar, Timothée Jacquesson, Romain Manet & Emmanuel Jouanneau

  3. CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon, Lyon, France

    Timothée Jacquesson

  4. Claude Bernard Lyon 1 University, University of Lyon, Lyon, France

    Timothée Jacquesson, Gerald Raverot & Emmanuel Jouanneau

  5. Department of Radiotherapy, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France

    Ciprian Enachescu

  6. Endocrinology Department, Reference Center for Rare Pituitary Diseases, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France

    Gerald Raverot

  7. CNRS UMR5286, Inserm U1052, Cancer research Center of Lyon, Lyon, France

    Gerald Raverot & Emmanuel Jouanneau

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Correspondence to Sam Ng.

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Electronic supplementary material

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Supplementary file 1 (DOCX 14 kb)

Supplementary file 2 (DOCX 33 kb)

11060_2020_3396_MOESM3_ESM.tiff

Supplementary Material 3: Survival analysis based on surgical technique: Biopsy versus Debulking versus Gross Total resection. N=99. (TIFF 253 kb)

11060_2020_3396_MOESM4_ESM.tiff

Supplementary Material 4: Survival analysis based on radiotherapy technique: conventional multifractional radiotherapy versus stereotactic radiotherapy. N=103. (TIFF 718 kb)

11060_2020_3396_MOESM5_ESM.tiff

Supplementary Material 5: Survival analysis based on radiotherapy technique: conventional multifractional radiotherapy versus stereotactic radiotherapy after 2010. N=36. (TIFF 674 kb)

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Ng, S., Fomekong, F., Delabar, V. et al. Current status and treatment modalities in metastases to the pituitary: a systematic review. J Neurooncol 146, 219–227 (2020). https://doi.org/10.1007/s11060-020-03396-w

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  • DOI: https://doi.org/10.1007/s11060-020-03396-w

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