Temporal Trends, Regional Analysis, and Characteristics of Utilization of Stereotactic Radiosurgery for Pituitary Tumors in the United States: Analyses from the National Cancer Database

Introduction: Stereotactic radiosurgery (SRS) has been increasingly employed to treat intracranial pathologies. For pituitary tumors, SRS has been shown to have favorable outcomes for residual or recurrent pituitary adenomas. However, a comprehensive review of use of SRS for pituitary tumors has not been performed. In the current study, we sought to evaluate temporal and regional trends of utilization of SRS for pituitary, and also to contrast patient and tumor characteristics of SRS-treated pituitary tumors with those treated with conventional modalities.

Methods: The National Cancer Database (NCDB) was queried for all pituitary tumors (ICD-O-3 topography code: C751) diagnosed between 2004 and 2017. Patients were grouped into those treated with SRS and those not treated with SRS. Temporal and regional trends of utilization were analyzed. Moreover, we also compared demographic, clinical, tumor, treatment, and facility characteristics between the two groups.

Results: A total of 119,288 patients with pituitary tumors were identified between 2004 and 2017, of which 1,941 (1.7%) were treated with SRS. Yearly utilization of SRS was observed to decrease from 2.6% of pituitary tumors undergoing SRS in 2004 to 1.16% tumors in 2017. Upon examining regional utilization, the highest utilization was found to be for institutions in the New England area (3.17%), followed by East South Central region (2.65%) and Pacific region (2.1%) while the lowest utilization was found to be for institutions in the East North Central region (1.59%). Patients undergoing SRS were more likely to be older (41–65: 52.4 vs. 42.3%; >65: 21.6 vs. 19.2%; p < 0.001), more likely to be males (48.9 vs. 46.2%, p = 0.017), more likely to have private insurance (58.7 vs. 54.8%, p < 0.001) and more likely to have traveled longer distance to receive their care (48.3 miles vs. 41.8, p = 0.045). The most commonly treated histology in the SRS group was found to be pituitary adenoma (83.7%, n = 1,625) followed by adenocarcinoma in situ (14%, n = 253). Patients in the SRS group were found to have larger tumors (mean tumor size: 3.28 vs. 2.41 cm, p < 0.001). This may be due to the fact that most patients undergoing SRS are those with either residual tumor or recurrent tumors that have undergone surgical resection. Seventy-two % patients in the SRS group also underwent a surgical resection, while the remaining underwent SRS alone, with or without systemic treatment or hormonal therapy.

Conclusion: While several studies have touted benefits of SRS for patients with recurrent or residual tumors, our analyses indicate that utilization of SRS may be declining nationally. This may be attributed to innovation in surgical techniques for endoscopic resection of pituitary tumors allowing for more optimal resection

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021