Aggressive pituitary neuroendocrine tumors: current practices, controversies, and perspectives, on behalf of the EANS skull base section

被引:9
|
作者
Ng, Sam [1 ]
Messerer, Mahmoud [2 ]
Engelhardt, Julien [3 ]
Bruneau, Michael [4 ]
Cornelius, Jan Frederick [5 ]
Cavallo, Luigi Maria [6 ]
Cossu, Giulia [2 ]
Froelich, Sebastien [7 ]
Meling, Torstein R. [8 ]
Paraskevopoulos, Dimitrios [9 ]
Schroeder, Henry W. S. [10 ]
Tatagiba, Marcos [11 ]
Zazpe, Idoya [12 ]
Berhouma, Moncef [13 ]
Daniel, Roy T. [2 ]
Laws, Edward R. [14 ]
Knosp, Engelbert [15 ]
Buchfelder, Michael [16 ]
Dufour, Henri [17 ]
Gaillard, Stephane [18 ]
Jacquesson, Timothee [19 ]
Jouanneau, Emmanuel [19 ]
机构
[1] Montpellier Univ, Dept Neurosurg, Med Ctr, Montpellier, France
[2] Univ Hosp Lausanne, Ctr Hosp Univ Vaudois, Dept Neurosurg, Dept Neurosci, Lausanne, Switzerland
[3] Ctr Hosp Univ Bordeaux, Dept Neurosurg, Bordeaux, France
[4] Vrije Univ Brussel, Univ Ziekenhuis Brussel, Dept Neurosurg, Brussels, Belgium
[5] Heinrich Heine Univ Dusseldorf, Med Fac, Dept Neurosurg, Dusseldorf, Germany
[6] Univ Hosp Naples Federico II, Dept Neurosurg, Naples, Italy
[7] Univ Paris Diderot, Lariboisiere Hosp, Dept Neurosurg, Paris, France
[8] Univ Hosp Geneva, Dept Neurosurg, Geneva, Switzerland
[9] Barts Hlth NHS Trust, St Bartholomews & Royal London Hosp, Dept Neurosurg, London, England
[10] Univ Med Greifswald, Dept Neurosurg, Greifswald, Germany
[11] Univ Hosp Tubingen, Dept Neurosurg, Tubingen, Germany
[12] Complejo Hosp Navarra, Dept Neurosurg, Pamplona, Spain
[13] Hosp Civils Lyon, Vasc & Neurooncol Surg Dept, Hop Neurol Pierre Wertheimer, Lyon, France
[14] Harvard Med Sch, Pituitary & Neuroendocrine Ctr, Brigham & Womens Hosp, Dept Neurosurg, Boston, MA USA
[15] Med Univ Vienna, Dept Neurosurg, Vienna, Austria
[16] Univ Erlangen Nurnberg, Dept Neurosurg, Erlangen, Germany
[17] Hop La Timone, AP HM, Dept Neurosurg, Marseille, France
[18] Hop La Pitie Salpetriere, AP HP, Dept Neurosurg, Paris, France
[19] Hop Neurol & Neurochirurg P Wertheimer, Skull Base & Pituitary Neurosurg Dept, Hosp Civils Lyon, Lyon, France
关键词
Aggressive pituitary adenoma; Atypical pituitary adenoma; PitNet; Pituitary carcinoma; Transsphenoidal surgery; Radiotherapy; Temozolomide; Neuro-oncology; Endocrine tumors; CAVERNOUS SINUS INVASION; TEMOZOLOMIDE TREATMENT; RADIONUCLIDE THERAPY; EUROPEAN-SOCIETY; ADENOMAS; CARCINOMAS; MANAGEMENT; CLASSIFICATION; SURGERY; GROWTH;
D O I
10.1007/s00701-021-04953-6
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Aggressive pituitary neuroendocrine tumors (APT) account for 10% of pituitary tumors. Their management is a rapidly evolving field of clinical research and has led pituitary teams to shift toward a neuro-oncological-like approach. The new terminology "Pituitary neuroendocrine tumors" (PitNet) that was recently proposed to replace "pituitary adenomas" reflects this change of paradigm. In this narrative review, we aim to provide a state of the art of actual knowledge, controversies, and recommendations in the management of APT. We propose an overview of current prognostic markers, including the recent five-tiered clinicopathological classification. We further establish and discuss the following recommendations from a neurosurgical perspective: (i) surgery and multi-staged surgeries (without or with parasellar resection in symptomatic patients) should be discussed at each stage of the disease, because it may potentialize adjuvant medical therapies; (ii) temozolomide is effective in most patients, although 30% of patients are non-responders and the optimal timeline to initiate and interrupt this treatment remains questionable; (iii) some patients with selected clinicopathological profiles may benefit from an earlier local radiotherapy and/or chemotherapy; (iv) novel therapies such as VEGF-targeted therapies and anti-CTLA-4/anti-PD1 immunotherapies are promising and should be discussed as 2nd or 3rd line of treatment. Finally, whether neurosurgeons have to operate on "pituitary adenomas" or "PitNets," their role and expertise remain crucial at each stage of the disease, prompting our community to deal with evolving concepts and therapeutic resources.
引用
收藏
页码:3131 / 3142
页数:12
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