Endocrine Abstracts

Background: Metastases to the sellar region are extremely rare tumours in surgical series. The reported incidence has recently increased with advances in neuroimaging. Survival of patients with metastatic cancer has improved due to progress in oncologic therapies and diagnostics. Patients with sellar metastases (SM) follow a variable disease course that is not well defined.

Objective: The objective was to evaluate the clinical characteristics, surgical approaches, and survival outcomes of SM diagnosed and treated at our institution.

Methods: 56 patients (29/51·8% women and 27/48·2% men) with histologically confirmed SM were identified between the years 1982 and 2022. Their data were retrospectively collected and analyzed.

Results: Breast cancer in women (23·2%) and renal cell cancer in men (14·3%) were the most common primary malignancies. The median age at diagnosis of SM was 64·8 years (range 19·8-83·7). Patients presented with visual deficits (92·3% [36/39]), cranial nerve palsies (50·0% [28/56]), and headaches (23·2% [13/56]). Diabetes insipidus was noted in four patients (7%). The mean tumor volume was 9·4±10·8 cm³ (median 6·0 cm³ [range 0·04-52·9]). In 13 patients (23·2%), SM were found before the diagnosis of the primary cancer. These were all cases of lung cancer. The mean time in months from primary cancer diagnosis to SM was 96·7±61·5 for breast, 99·5±50·4 for renal cell, 37·0±31·1 for gastrointestinal, and 46·0±14·1 for prostate cancer. SM occurred intra- and parasellar (8, 14%), supra- (17, 30%), and intra- and suprasellar (21, 38%). In most cases, surgery was performed through a transsphenoidal approach (58·8%) and the transcranial approach was used in 17 cases (30·4%). Seven patients (12·5%) underwent other procedures. Gross total resection was achieved in only 5 patients (9%). 35 patients (62·5%) received adjuvant radiotherapy. One year after surgery, 26 of 53 patients (49·1%) were alive, 19 (35·8%) were alive after two years, and only one (1·9%) was alive after five years. The mean duration of follow-up in months was 23·4±39·5 (median 9·6 [range 0·3-265·5]).

Conclusions: The diagnosis of SM has always been delayed. Lung cancer patients are most at risk for sellar metastasis at primary tumor diagnosis. The overall survival of patients diagnosed with SM is poor. The extent of the resection of the SM does not affect survival. Surgery is effective for mass reduction and rapid symptomatic improvement of vision and headache. In some cases, it provides a definitive diagnosis of the primary tumor.