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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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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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  1. Sam Ng
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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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