title: Therapy of aggressive pituitary tumors.
abstract: BACKGROUND
  Aggressive tumors of the pituitary gland are classically defined as pituitary tumors with a massive invasion of the surrounding anatomical structures and rapid growth. They are notoriously difficult to manage and are associated with poor prognosis because the therapeutic options are limited and the tumors are generally unresponsive to therapy.
  
  
  METHODS
  This review focuses on treatment options for aggressive pituitary tumors, including surgery, radiotherapy and medical treatment, as well as focusing on the promising therapeutic options for aggressive pituitary tumors, evaluating the literature of the last 15 years. With the exception of prolactinomas, surgery is the first-line option, but most aggressive pituitary tumors often require repeated surgery. Pharmacotherapies are useful when surgery is unlikely to improve symptoms, or as an adjunct therapy to surgery. In prolactinomas, dopamine agonists are the first-line treatment and normalize prolactin levels in most patients, even those with macroprolactinomas. Somatostatin analogs are effective agents for primary therapy, pre-operatively or post-operatively to control tumor re-expansion of pituitary adenomas. However, dopamine agonists and somatostatin analogs are not as effective as they are for the treatment of non-aggressive adenomas. When surgery and pharmacotherapy fail, radiotherapy is a useful third-line strategy. Conventional chemotherapy is poorly effective but recent case reports with the temozolomide, an alkylating agent, have provided better results in the short term.
  
  
  CONCLUSIONS
  Aggressive pituitary tumors are associated with poor prognosis as therapeutic options are limited. Moreover, they tend to recur quickly after initial treatment, are generally unresponsive to therapy, and are difficult to manage. To improve the overall response rate, the early application of current therapeutic approaches with the incorporation of new therapeutic developments is mandatory.
authors: Federico II University, Department of Molecular and Clinical Endocrinology and Oncology, via S. Pansini 5, 80131 Napoli, Italy.
authors: Annamaria
authors: A
authors: Colao
authors: Ludovica F S
authors: LF
authors: Grasso
authors: Rosario
authors: R
authors: Pivonello
authors: Gaetano
authors: G
authors: Lombardi
mesh_terms: D000236:Adenoma / Q000503:physiopathology / Q000628:therapy; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010911:Pituitary Neoplasms / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D015175:Prolactinoma / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents