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Surgical Management and Long-term Outcomes in Pituitary Carcinoma: A Single-Institution Experience

Friday, May 3, 2024

Presenting Author(s)

Christina Abi Faraj, MD (she/her/hers)

Postdoctoral research fellow.
Department of Neurosurgery, MD Anderson Cancer Center
Houston, TX, US

Co-Author(s)

SF

Sherise D. Ferguson, MD

Associate Professor
Department of Neurosurgery, MD Anderson Cancer Center
Houston, Texas, United States
GF

Gregory Fuller, MD, PhD

Professor
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
NM

Nazanin Majd, MD, PhD

Assistant Professor
Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
Ian E. McCutcheon, MD

Professor
Department of Neurosurgery, MD Anderson Cancer Center
HOUSTON, TX, United States
MT

Maxwell Tran, MD

Resident
Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA., United States
SW

Stephen Waguespack, MD

Professor
Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States

Introduction: Pituitary carcinomas (PCs) are a subset of pituitary tumors defined by metastasis. Due to their rarity, data regarding surgical management and predictors of patient outcomes are sparse.

Methods: We retrospectively reviewed patients with pituitary carcinoma who presented to MD Anderson Cancer Center between 1993-2022. Clinical, pathologic, and radiographic characteristics were recorded and analyzed using standard statistical methods.

Results: Among 19 patients (63% males), median age was 45 (17-81) years. Median follow-up was 12.7 years. Most PCs were hormone-secreting (n=12), with ACTH-secreting (n=5) and prolactin-secreting (n=4) being most common. Median interval from pituitary adenoma (PA) to PC is 8 (1.5-26.2) years. Median MIB-1 of PA was 10%. Twelve (63%) patients had locoregional invasion, most commonly to the cavernous sinus, at PA diagnosis. MIB-1 >10% (versus ≤10%, p=0.12), locoregional invasion (p=0.29), and tumor type (p=0.89) were not significantly associated with the interval from PA to PC. Eleven patients displayed metastases limited to the CNS, while four had CNS and systemic metastases. The most common systemic locations were bone (75%) and liver (50%). Surgical debulking of recurrent sellar/parasellar tumor after metastasis onset was done in six patients to relieve mass effect on nearby structures. Of these, two developed CSF leak and one developed epidural/subdural hematoma postoperatively. Median number of operations from PA diagnosis was 5 per patient. The 1-, 2-, and 5-year survival rates were 78, 67, and 49% respectively. Of those surviving >5 years, 75% were below age 45 years at PC diagnosis. Surgical debulking of PC (p=0.41), metastasis location (p=0.40), locoregional invasion (p=0.28), and MIB-1 of PA (p=0.33) were not associated with survival. Management in most cases entailed surgical resection of sellar/parasellar or metastatic lesion and radiotherapy, followed by chemotherapy.

Conclusion : Prolonged survival is possible with aggressive multimodal therapy. Further improvements in early identification of PC and targeted therapies are key to improving survival.