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Case Reports
. 2016 Aug;19(4):415-21.
doi: 10.1007/s11102-016-0721-6.

Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

Carlos Kamiya-Matsuoka  1 , David Cachia  2 , Steven G Waguespack  3 , Christopher H Crane  4 , Anita Mahajan  4 , Paul D Brown  4 , Joo Yeon Nam  5 , Ian E McCutcheon  6 , Marta Penas-Prado  5
Affiliations
Case Reports

Radiotherapy with concurrent temozolomide for the management of extraneural metastases in pituitary carcinoma

Carlos Kamiya-Matsuoka et al. Pituitary. 2016 Aug.

Abstract

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.

Keywords: Capecitabine; Chemoradiation; Pituitary carcinoma; Pituitary macroadenoma; Temozolomide.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Case 1: Radiologic findings of surgical site and extraneural metastases before and after chemoradiation with temozolomide
(A) Pre-operative sagittal image with T1-weighted gadolinium-enhanced MRI demonstrates a non-enhancing mass measuring 4.7 x 3.7 x 5.4 cm (white arrowheads) involving the lateral wall of the right sphenoid sinus, nasopharynx, right middle cranial fossa, and masticator space. (B) MRI shows postoperative changes in the right masticator space. All of the previously seen masticator space disease has been resected. A large fluid space is present below the temporal lobe. (C) PET scan for treatment planning purposes shows FDG-avid soft tissue density in the left posterior ethmoid air cells and the region of the right sphenoid sinus (suspicious for residual carcinoma) as well as in the mediastinum and hilar lymph nodes (black arrowheads). MRI (D and E) and PET scan (F) 2 years after chemoradiation shows stable findings in the masticator space and reduction of activity in the left posterior ethmoid sinus as well as the mediastinal and left hilar nodes.
Figure 2
Figure 2. Case 2: Radiologic findings of portacaval adenopathies before and after chemoradiation with temozolomide
(A) PET scan shows 2 FDG-avid portacaval lymph nodes (black arrowheads). (B) CT of abdomen confirms the 2 masses measuring 2.1 x 2.1 cm and 3.0 x 3.6 cm (white arrowheads). (C) Radiation therapy planning. (D) 16 months after chemoradiation to the portacaval region, the adenopathy has decreased in size (white arrowheads) but unfortunately the hepatic metastasis has increased.
See this image and copyright information in PMC

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