A great study revealing the "natural" history of pituitary tumor growth rates. Authors find that nonfunctional pituitary adenomas grow fast without intervention (65%), moderately after surgery (35%) and least after radiation therapy (13%) during the first 5 years. Growth rates are slower after the second surgery (25%) and nonexistent (0%) after the second XRT in the following 5 year interval. This is a significant information regarding outcome expectations, and needs to be shared with affected individuals.
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Context: Despite the major risk of regrowth of clinically nonfunctioning pituitary adenomas (CNFAs) after primary treatment, systematic data on the probability of further tumor progression and the effectiveness of management approaches are lacking.
Objective: To assess the probability of further regrowth(s), predictive factors, and outcomes of management approaches in patients with CNFA diagnosed with adenoma regrowth after primary treatment.
Patients, Design, and Setting: Retrospective cohort study of 237 patients with regrown CNFA managed in two UK centers.
Results: Median follow-up was 5.9 years (range, 0.4-37.7 years).
The 5-year 2nd regrowth rate was 35.3% (36.2% after surgery; 12.5% after radiotherapy; 12.7% after surgery combined with radiotherapy; 63.4% with monitoring).
Of those managed with monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for second regrowth.
Among those with second adenoma regrowth, the 5-year 3rd regrowth rate was 26.4% (24.4% after surgery; 0% after radiotherapy; 0% after surgery combined with radiotherapy; 48.3% with monitoring).
Overall, patients with a CNFA regrowth had a 4.4% probability of a third regrowth at 5 years and a 10.0% probability at 10 years; type of management of the first regrowth was the only risk factor.
Malignant transformation was diagnosed in two patients.
Patients with regrown CNFA after primary treatment continue to carry considerable risk of tumor progression, necessitating long-term follow-up.
Management approach to the regrowth was the major factor determining this risk; monitoring had >60% risk of progression at 5 years, and a substantial number of patients ultimately required intervention.