ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)
Progression of potentially aggressive PitNETs after radiotherapy: risk factors, management, and outcomes
Fabio Bioletto 1,2 , Caroline Bogeat 3 , Maxime Barat 1,4 , Nesrine Benanteur 1 , Laurence Guignat 4 , Mirella Hage 3,5 , Cyril Garcia 6 , Valentin Calugaru 7 , Julian Jacob 8 , Jennifer Arrondeau 4 , Lionel Groussin 1,4 , Xavier Bertagna 1,4 , Jérôme Bertherat 1,4 , Chiara Villa 1,9 , Anne Jouinot 1 , Bertrand Baussart 1,9 & Guillaume Assié 1,4
1Université Paris Cité, Institut Cochin, Institut Cochin, Paris, France; 2University of Turin, Department of Medical Sciences, Turin, Italy; 3Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Paris, France; 4Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, Paris, France; 5Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; 6Hôpital National d’Instruction des Armées Bégin, Saint-Mandé, France; 7PSL Research University, Institut Curie, Paris, France; 8Assistance Publique–Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Paris, France; 9Assistance Publique–Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
JOINT642
Objective: Radiotherapy plays a relevant role in pituitary neuroendocrine tumors (PitNETs) uncontrolled by surgery and resistant to medical treatments. Radiotherapy controls tumor progression in most cases, but not always. Prognostic factors for tumor progression after radiotherapy remain poorly defined. The aim was to evaluate tumor progression after radiotherapy, to identify risk factors, and to report management and outcomes in a cohort of PitNETs with uncontrolled progression.
Design: Retrospective, single-center, observational study.
Methods: In total, 123 consecutive patients who underwent radiotherapy for PitNETs and were followed at Cochin Hospital between 2000 and 2022 were included. Radiotherapy was performed in the following situations: uncontrolled tumor progression (80%), adjuvant (9%), or uncontrolled secretion (11%). Median follow-up after radiotherapy was 10.0 years.
Results: Tumor progression after radiotherapy was observed in 28/123 (23%) patients. Progression-free survival was 95, 86 and 78% at 2, 5, and 10 years from radiotherapy, respectively. Higher risk of progression was associated with lactotroph and corticotroph tumor types (HR 12.0, 95%CI 1.2 to 117.1 and HR 9.3, 95%CI 1.3 to 69.6, respectively), male sex (HR 3.7, 95%CI 1.6 to 8.4), and evidence of necrotic-hemorrhagic changes before radiotherapy on MRI (HR 3.1, 95%CI 1.1 to 8.4). Surgery, temozolomide and re-irradiation were the most frequent treatments for the management of tumor progression after radiotherapy, used in 18/28 (64%), 16/28 (57%) and 8/28 (29%) cases, respectively. Other treatment approaches included immunotherapy, anti-VEGF antibodies, EGFR tyrosine kinase inhibitors, peptide radionuclide therapy, cisplatin, and enzalutamide. The most common complication of radiotherapy was the new onset of pituitary deficits, observed in 41% of cases; other complications, including radiation-induced neuroinflammation, cerebrovascular events, and second brain tumors, were rare (3%, 2%, 2%, respectively). Among the 8 patients who experienced re-irradiation, median progression-free survival was 1.4 years, with 2/8 patients maintaining tumor control in the long term (>5 years). The safety profile was acceptable, with only one case of optic neuropathy. Overall, 3 patients developed metastases, and 6 patients died because of tumor progression.
Conclusion: Radiotherapy is an effective and generally safe treatment for the achievement of tumor control in patients with PitNETs with aggressive potential. Tumor progression can still occur in some cases, and can pose challenges in clinical management. Histological tumor type, sex, and necrotic-hemorrhagic components at MRI hold a prognostic value in predicting tumor progression risk. Being all simple and available markers, they can be useful in clinical practice for optimizing therapeutic strategies and personalizing patient care.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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