Giuseppe Minniti1,2, Sergio Paolini3, Marie Lise Jaffrain Rea4, Andrea Isidori5, Claudia Scaringi6, Ivana Russo7, Mattia Falchetto Osti8, Luigi Cavallo9, Vincenzo Esposito3. 1. Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100, Siena, Italy. giuseppe.minniti@unisi.it. 2. IRCCS Neuromed, Pozzilli, IS, Italy. giuseppe.minniti@unisi.it. 3. IRCCS Neuromed, Pozzilli, IS, Italy. 4. Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, L'Aquila, Italy. 5. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. 6. UPMC Hillman Cancer Center, San Pietro Hospital FBF, Rome, Italy. 7. UPMC Hillman Cancer Center, Villa Maria, Mirabella, AV, Italy. 8. Radiation Oncology Unit, Sant' Andrea Hospital, "Sapienza" University, Rome, Italy. 9. Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
Abstract
OBJECTIVES: To evaluate the efficacy of a second course of fractionated stereotactic radiotherapy (re-SRT) and temozolomide (TMZ) as salvage treatment option in patients with aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs). PATIENTS AND METHODS: Twenty-one patients with recurrent or progressive APTs (n = 17) and PCs (n = 4) who received combined TMZ and re-SRT, 36 Gy/18fractions or 37.5 Gy/15fractions, were retrospectively evaluated. TMZ was given at a dose of 75 mg/m2 given concurrently to re-SRT, and then 150-200 mg/m2/day for 5 days every 4 weeks or 50 mg/m2 daily for 12 months. Local control (LC) and overall survival (OS) were calculated from the time of re-SRT by Kaplan-Meier method. RESULTS: With a median follow-up of 27 months (range 12-58 months), 2-year and 4-year LC rates were 73% and 65%, respectively; 2-year and 4-year survival rates were 82% and 66%, respectively. A complete response was achieved in 2 and partial response in 11 patients. Six patients recurred with a median time to progression of 14 months. O(6)-Methylguanine-DNA methyltransferase (MGMT) status and tumor volume emerged as prognostic factors. Grade 3 radiation-related toxicities occurred in 3 (14%) patients. Grade 2 or 3 hematologic toxicities during chemotherapy occurred in 8 (38%) patients. CONCLUSION: Re-SRT and TMZ is a safe treatment offering high LC in patients with progressive APTs and PCs. The potential advantages of combined chemoradiation as up-front or salvage treatment need to be explored in prospective trials.
OBJECTIVES: To evaluate the efficacy of a second course of fractionated stereotactic radiotherapy (re-SRT) and temozolomide (TMZ) as salvage treatment option in patients with aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs). PATIENTS AND METHODS: Twenty-one patients with recurrent or progressive APTs (n = 17) and PCs (n = 4) who received combined TMZ and re-SRT, 36 Gy/18fractions or 37.5 Gy/15fractions, were retrospectively evaluated. TMZ was given at a dose of 75 mg/m2 given concurrently to re-SRT, and then 150-200 mg/m2/day for 5 days every 4 weeks or 50 mg/m2 daily for 12 months. Local control (LC) and overall survival (OS) were calculated from the time of re-SRT by Kaplan-Meier method. RESULTS: With a median follow-up of 27 months (range 12-58 months), 2-year and 4-year LC rates were 73% and 65%, respectively; 2-year and 4-year survival rates were 82% and 66%, respectively. A complete response was achieved in 2 and partial response in 11 patients. Six patients recurred with a median time to progression of 14 months. O(6)-Methylguanine-DNA methyltransferase (MGMT) status and tumor volume emerged as prognostic factors. Grade 3 radiation-related toxicities occurred in 3 (14%) patients. Grade 2 or 3 hematologic toxicities during chemotherapy occurred in 8 (38%) patients. CONCLUSION: Re-SRT and TMZ is a safe treatment offering high LC in patients with progressive APTs and PCs. The potential advantages of combined chemoradiation as up-front or salvage treatment need to be explored in prospective trials.
Authors: Justin T Jordan; Julie J Miller; Tucker Cushing; Marlon Seijo; Tracy T Batchelor; Isabel C Arrillaga-Romany; Helen A Shih; Lisa B Nachtigall; Jay S Loeffler; Jorg Dietrich Journal: Neurooncol Pract Date: 2017-05-26
Authors: Stephanie Du Four; Jorn Van Der Veken; Johnny Duerinck; Elle Vermeulen; Corina E Andreescu; Michael Bruneau; Bart Neyns; Van Velthoven; Brigitte Velkeniers Journal: Front Endocrinol (Lausanne) Date: 2022-09-08 Impact factor: 6.055