Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma.
BACKGROUND
Pituitary carcinomas (PC) are uncommon neuroendocrine tumors, accounting for 0.1 % of all pituitary tumors. The diagnosis of PC is based on the presence of metastases from a pituitary adenoma, and not by local invasion or pathological features alone. PC is typically resistant to therapy, with a median overall survival of only 31 months. There is no standard treatment for PC, but maximal safe resection and radiation are performed when possible. Encouraging preliminary data on the use of temozolomide (TMZ)-based therapy has been previously reported.


METHODS
We report the response to therapy and safety of radiation with concurrent temozolomide (RT/TMZ) in 2 adult patients with heavily pretreated PC and extraneural metastases.


RESULTS
Both patients had prior history of pituitary macroadenoma. At the time of diagnosis of PC, Ki-67 % was 24.2 and 10 %, with positive p53 staining in one case. Metastatic sites included lymph nodes, liver and bone. Case-1 received RT/TMZ to the tumor bed in the skull base and to the metastases in the cervical lymph nodes. Case-2 received RT/TMZ to recurrent tumor involving portacaval lymph nodes. Both patients achieved excellent long-term control of the sites of treated extraneural metastases, with no significant acute or delayed toxicity.


CONCLUSIONS
RT/TMZ was safely delivered and might provide sustained control of extraneural metastases in PC. Although this retrospective report has limitations, RT/TMZ can be considered as a therapeutic option for the management of extraneural metastases in PC.
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Room FC7.3000, Unit 431, Houston, TX, 77030, USA. ckamiya@mdanderson.org.
Carlos
C
Kamiya-Matsuoka
Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
David
D
Cachia
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Steven G
SG
Waguespack
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Christopher H
CH
Crane
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Anita
A
Mahajan
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Paul D
PD
Brown
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Room FC7.3000, Unit 431, Houston, TX, 77030, USA.
Joo Yeon
JY
Nam
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ian E
IE
McCutcheon
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, Room FC7.3000, Unit 431, Houston, TX, 77030, USA.
Marta
M
Penas-Prado
D000236:Adenoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D000077204:Temozolomide
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
Capecitabine; Chemoradiation; Pituitary carcinoma; Pituitary macroadenoma; Temozolomide