title: A Rapid Biochemical and Radiological Response to the Concomitant Therapy with Temozolomide and Radiotherapy in an Aggressive ACTH Pituitary Adenoma.
abstract: Background and Importance. In the last eight years temozolomide (TMZ) has been used as the last-line treatment modality for aggressive pituitary tumors to be applied after the failure of surgery, medical therapy, and radiotherapy. The objective was to achieve a rapid control of tumor growth and hormone normalization with concurrent chemoradiotherapy in a patient with very aggressive ACTH pituitary adenoma.Clinical Presentation. We describe a patient with an aggressive ACTH-producing adenoma treated with concurrent temozolomide and radiotherapy. The patient suffered from an aggressive ACTH adenoma resistant to surgical and medical treatment. After two months of concurrent temozolomide and radiotherapy, cortisol normalization and significant tumor shrinkage were observed. After 22 months of follow-up, there is still no evidence of tumor recurrence.Conclusion. Concurrent treatment with temozolomide and irradiation appears to be highly effective in the achievement of the tumor volume control as well as in the control of ACTH secretion in aggressive ACTH adenoma.
authors.affiliation: Department of Oncology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Ana
authors.identifier: 0000-0002-6184-7104
authors.initials: A
authors.lastname: Misir Krpan
authors.affiliation: Zagreb University School of Medicine, Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Tina
authors.identifier: 0000-0002-1266-3501
authors.initials: T
authors.lastname: Dusek
authors.affiliation: Department of Oncology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Zoran
authors.identifier: 0000-0002-5148-336X
authors.initials: Z
authors.lastname: Rakusic
authors.affiliation: Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Mirsala
authors.identifier: 0000-0002-4219-9287
authors.initials: M
authors.lastname: Solak
authors.affiliation: Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Ivana
authors.identifier: 0000-0002-4379-2250
authors.initials: I
authors.lastname: Kraljevic
authors.affiliation: Osijek University School of Medicine, Department of Oncology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Vesna
authors.identifier: 0000-0002-2826-9664
authors.initials: V
authors.lastname: Bisof
authors.affiliation: Department of Radiology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: David
authors.identifier: 0000-0002-2154-1506
authors.initials: D
authors.lastname: Ozretic
authors.affiliation: Zagreb University School of Medicine, Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
authors.forename: Darko
authors.identifier: 0000-0003-3034-5598
authors.initials: D
authors.lastname: Kastelan