• Georgios A Maragkos, Georgios Mantziaris, Stylianos Pikis, Tomas Chytka, Roman Liscak, Selcuk Peker, Yavuz Samanci, Shray K Bindal, Ajay Niranjan, L Dade Lunsford, Rupinder Kaur, Renu Madan, Manjul Tripathi, Dhiraj J Pangal, Ben A Strickland, Gabriel Zada, Anne-Marie Langlois, David Mathieu, Ronald E Warnick, Samir Patel, Zayda Minier, Herwin Speckter, Douglas Kondziolka, Cheng-Chia Lee, Mary Lee Vance, and Jason P Sheehan.
• Department of Neurological Surgery, University of Virginia Health System, Charlottesville , Virginia , USA.
• Neurosurgery. 2023 Dec 1; 93 (6): 140714141407-1414.

Background And ObjectivesThere is conflicting evidence on the significance of adrenocorticotrophic hormone (ACTH) staining in the prognosis of nonfunctioning pituitary neuroendocrine tumors (NFpitNETs). The objective of this study was to define the effect of ACTH immunostaining on clinical and radiographic outcomes of stereotactic radiosurgery (SRS) for NFpitNETs.MethodsThis retrospective, multicenter study included patients managed with SRS for NFpitNET residuals. The patients were divided into 2 cohorts: (1) silent corticotroph (SC) for NFpitNETs with positive ACTH immunostaining and (2) non-SC NFpitNETs. Rates of local tumor control and the incidence of post-treatment pituitary and neurological dysfunction were documented. Factors associated with radiological and clinical outcomes were also analyzed.ResultsThe cohort included 535 patients from 14 centers with 84 (15.7%) patients harboring silent corticotroph NFpitNETs (SCs). At last follow-up, local tumor progression occurred in 11.9% of patients in the SC compared with 8.1% of patients in the non-SC cohort (P = .27). No statistically significant difference was noted in new-onset hypopituitarism rates (10.7% vs 15.4%, P = .25) or visual deficits (3.6% vs 1.1%, P = .088) between the 2 cohorts at last follow-up. When controlling for residual tumor volume, maximum dose, and patient age and sex, positive ACTH immunostaining did not have a significant correlation with local tumor progression (hazard ratio = 1.69, 95% CI = 0.8-3.61, P = .17).ConclusionIn contemporary radiosurgical practice with a single fraction dose of 8-25 Gy (median 15 Gy), ACTH immunostaining in NFpitNETs did not appear to confer a significantly reduced rate of local tumor control after SRS.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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