Pituitary Tumors and Carcinomas
European Society of Endocrinology
Recommend all pituitary tumors undergo histopathologic analysis, which should include, at a minimum, immunodetection of pituitary hormones and Ki-67 proliferative index evaluation. The p53 immunodetection and the mitotic count should be evaluated at least when the Ki-67 index is ≥3%.
Suggest adjuvant radiotherapy be considered in the setting of a clinically relevant invasive tumor remnant with pathologic markers (Ki-67 index; mitotic count; p53 immunodetection) strongly indicating aggressive behavior.
Recommend use of temozolomide monotherapy as first-line chemotherapy for aggressive pituitary tumors and pituitary carcinomas, following documented tumor growth.
Recommend first evaluation of treatment response after 3 cycles. If radiologic progression is demonstrated, temozolomide treatment should be ceased.
Recommend use of the standard dosing regimen: 150-200 mg/m2 for 5 consecutive days every 28 days.
Suggest, in patients with rapid tumor growth in whom maximal doses of radiotherapy have not been reached, combination temozolomide with radiotherapy (Stupp protocol).
In patients responding to first-line temozolomide, as assessed after 3 cycles, suggest treatment to be continued for at least 6 months in total, with consideration for longer duration if continued therapeutic benefit is observed.
In patients who develop a recurrence following response to temozolomide treatment, suggest a second trial of 3 cycles of temozolomide.
Recommend imaging (MRI in most instances) be performed every 3 to 12 months as guided by prior tumor growth rate and/or location of tumor (proximity to vital structures).
Raverot G, Burman P, McCormack A, et al. European Society of Endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol. 2017 Oct 18.
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Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, November 2017 - Medscape - Nov 08, 2017.