Stereotactic radiosurgery with or without surgical resection for pituitary adenoma: Insights from the National Cancer Database

Purpose: Stereotactic Radiosurgery (SRS) is an effective option for incompletely resected or recurrent pituitary adenoma. Herein, we evaluated the characteristics and outcomes of patients undergoing SRS for pituitary adenoma using a national cancer registry. Methods: National Cancer Database (NCDB) was queried for patients diagnosed with pituitary adenoma and treated with SRS between 2004 and 2017. Patients were grouped based on whether their treatment consisted of SRS alone or SRS plus a surgical procedure. Demographic, clinical, and treatment characteristics were compared between the two groups. Kaplan Meier survival curves and cox-regression analyses were performed to evaluate the impact of treatment type on survival. Results: A total of 1,625 patients who had undergone SRS for pituitary adenoma were identified. Of these, 1,189 (73.2%) also underwent a surgical procedure. Compared to patients undergoing SRS plus surgery, patients undergoing SRS alone were more likely to be older (>65: 43.3%, n = 189 vs 14.4%, n = 171; p < 0.001), have smaller tumors (≤3 cm; 92.1% vs 65.4%, p < 0.001), and have delayed treatment (days from diagnosis to treatment; 98 ± 123.4 vs 39.8 ± 67.2, p < 0.001). The five-year survival rate for the standalone SRS group was found to be 79.3% (95% CI 75.1–83.8), which was significantly lower compared to that for patients undergoing SRS following surgical resection (94.2% (95% CI 92.7–95.7)) (p < 0.001). Conclusion: Our analyses indicate that a treatment regimen consisting of surgery plus SRS is associated with lower mortality compared to SRS alone, despite its association with larger, more complex tumors.