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

Autor: Ng S; Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France. s-ng@chu-montpellier.fr., Messerer M; Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland., Engelhardt J; Department of Neurosurgery, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France., Bruneau M; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium., Cornelius JF; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany., Cavallo LM; Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy., Cossu G; Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland., Froelich S; Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France., Meling TR; Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland., Paraskevopoulos D; Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK., Schroeder HWS; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany., Tatagiba M; Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany., Zazpe I; Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain., Berhouma M; Vascular and Neuro-Oncological Surgical Departement, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France., Daniel RT; Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland., Laws ER; Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Knosp E; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria., Buchfelder M; Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany., Dufour H; Department of Neurosurgery, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France., Gaillard S; Department of Neurosurgery, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France., Jacquesson T; Skull Base and Pituitary Neurosurgical Department, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France., Jouanneau E; Skull Base and Pituitary Neurosurgical Department, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2021 Nov; Vol. 163 (11), pp. 3131-3142. Date of Electronic Publication: 2021 Aug 08.
DOI: 10.1007/s00701-021-04953-6
Abstrakt: 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.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: