title: Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature.
abstract: We present a case report of a patient recently treated at our institution for an isolated non-small cell lung cancer metastatic lesion to the sella, report the lack of involvement of the pituitary gland in a large single-institution series of treated intracranial parenchymal metastases, and review the pertinent literature. We reviewed cranial imaging studies (CT and MRI) for 935 metastases in 155 patients treated at our institution over the previous 3 years for intracranial metastatic disease. Special attention was paid to the skull base to document the presence of any metastatic disease involving the pituitary gland, infundibular stalk, sella turcica (including anterior and posterior clinoids), or diaphragm sellae. We found no other involvement of the pituitary gland or other sellar structures by metastatic disease in this series. Intracranial metastatic disease rarely involves the pituitary gland and infundibular stalk parenchyma, suggesting that this structure may be safely omitted from the treatment field during WBRT and prophylactic cranial irradiation (PCI). This treatment approach should reduce the late sequelae of treatment to this critical organ.
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA. james_c_marsh@rush.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Marsh
authors.forename: Shalini
authors.initials: S
authors.lastname: Garg
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wendt
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Gielda
authors.forename: Julius V
authors.initials: JV
authors.lastname: Turian
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Herskovic
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010902:Pituitary Gland / Q000473:pathology*
references.citation: Neurology. 1967 Dec;17(12):1190-2
references.pmid: 6070020
references.citation: J Clin Endocrinol Metab. 2007 May;92(5):1666-72
references.pmid: 17284618
references.citation: Neurol Med Chir (Tokyo). 2005 Aug;45(8):418-22
references.pmid: 16127262
references.citation: Recenti Prog Med. 2007 Feb;98(2):87-9
references.pmid: 17439068
references.citation: Am J Ophthalmol. 1995 Jun;119(6):779-85
references.pmid: 7785694
references.citation: Tumori. 2008 Sep-Oct;94(5):765-8
references.pmid: 19112958
references.citation: Nihon Kokyuki Gakkai Zasshi. 2003 Jan;41(1):48-53
references.pmid: 12693006
references.citation: Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):971-7
references.pmid: 17446005
references.citation: Urology. 2004 Sep;64(3):589-90
references.pmid: 15351603
references.citation: Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1480-5
references.pmid: 19625140
references.citation: N Engl J Med. 1999 Aug 12;341(7):476-84
references.pmid: 10441603
references.citation: Skull Base. 2009 Mar;19(2):133-40
references.pmid: 19721769
references.citation: Interact Cardiovasc Thorac Surg. 2009 Apr;8(4):467-73
references.pmid: 19155223
references.citation: Eur J Cardiothorac Surg. 2004 Jun;25(6):1107-13
references.pmid: 15145017
references.citation: J Child Neurol. 2009 Nov;24(11):1418-30
references.pmid: 19841429
references.citation: Stroke. 1995 Jan;26(1):131-6
references.pmid: 7839383
references.citation: Pituitary. 2005;8(3-4):203-11
references.pmid: 16508716
references.citation: Lung Cancer. 1999 May;24(2):99-106
references.pmid: 10444060
references.citation: J Neurosurg. 2010 Nov;113(5):1059-71
references.pmid: 19929198
references.citation: Cancer. 1978 Jan;41(1):130-7
references.pmid: 626923
references.citation: Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
references.pmid: 9128946
references.citation: J Clin Endocrinol Metab. 2005 Dec;90(12):6355-60
references.pmid: 16144946
references.citation: J Thorac Cardiovasc Surg. 2001 Sep;122(3):548-53
references.pmid: 11547308
references.citation: Arch Neurol. 2009 Aug;66(8):1036-7
references.pmid: 19667229
references.citation: Expert Rev Anticancer Ther. 2008 Dec;8(12):1931-8
references.pmid: 19046113
references.citation: Ann Endocrinol (Paris). 2005 Apr;66(2 Pt 1):117-20
references.pmid: 15959412
references.citation: Surg Neurol. 1986 Jan;25(1):49-54
references.pmid: 3941968
references.citation: ANZ J Surg. 2005 Nov;75(11):963-6
references.pmid: 16336388
references.citation: Arch Neurol. 1989 Apr;46(4):449-55
references.pmid: 2650664
references.citation: Urology. 2003 Aug;62(2):352
references.pmid: 12893361
references.citation: Intern Med. 2002 Oct;41(10):834-8
references.pmid: 12413005
references.citation: Stroke. 1992 Jun;23(6):908-11
references.pmid: 1595114
references.citation: Int J Radiat Oncol Biol Phys. 1999 Oct 1;45(3):693-8
references.pmid: 10524424
references.citation: Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):978-85
references.pmid: 17467925
references.citation: J Child Neurol. 2009 Nov;24(11):1397-408
references.pmid: 19841428
references.citation: Neurol Med Chir (Tokyo). 1991 Jun;31(6):336-41
references.pmid: 1724298
references.citation: Nat Clin Pract Endocrinol Metab. 2009 Feb;5(2):88-99
references.pmid: 19165221
references.citation: Can J Neurol Sci. 2007 Aug;34(3):322-7
references.pmid: 17803030
references.citation: Horm Res. 2008;69(2):65-74
references.pmid: 18059086
references.citation: Clin Endocrinol (Oxf). 2002 Dec;57(6):713-7
references.pmid: 12460319
references.citation: Endocr Dev. 2010;17:185-196
references.pmid: 19955767
references.citation: Pediatr Neurosurg. 2003 Nov;39(5):264-9
references.pmid: 14512691
references.citation: Neurosurg Focus. 2008;24(5):E2
references.pmid: 18447741
references.citation: Pituitary. 2009;12(1):40-50
references.pmid: 18270844
references.citation: Growth Horm IGF Res. 2004 Jun;14 Suppl A:S118-24
references.pmid: 15135792
references.citation: J Child Neurol. 2009 Nov;24(11):1431-8
references.pmid: 19841430
references.citation: Intern Med. 1994 Dec;33(12):795-8
references.pmid: 7718964
references.citation: Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):946-54
references.pmid: 20472348
references.citation: Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):589-97
references.pmid: 17869672
references.citation: J Neurosurg. 1989 Jul;71(1):138-40
references.pmid: 2661740
references.citation: Radiat Oncol. 2009 Oct 14;4:42
references.pmid: 19828022
references.citation: J Clin Oncol. 2004 Dec 1;22(23):4851-3
references.pmid: 15570089
references.citation: Cancer. 1989 Jun 15;63(12):2404-8
references.pmid: 2720586
references.citation: Rev Med Interne. 2009 May;30(5):425-9
references.pmid: 19231038
references.citation: Endocr Dev. 2009;15:1-24
references.pmid: 19293601
references.citation: J Endocrinol Invest. 1992 Oct;15(9):677-81
references.pmid: 1479150
references.citation: Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):504-12
references.pmid: 20117288
references.citation: Neuropediatrics. 2006 Dec;37(6):364-6
references.pmid: 17357039