MON-406 Two Cases of Aggressive Corticotroph Pituitary Tumors Treated with Capecitabine and Temozolomide
Notice bibliographique
Résumé
Introduction: Aggressive corticotroph tumors exhibit continued growth despite multimodal therapy, including surgeries, radiotherapy and/or medical treatment. Temozolomide (TMZ), an oral alkylating agent, has been used to treat aggressive pituitary tumors; however, most patients only showed a partial response. Recent evidence suggests that TMZ administered with capecitabine (CAP) is effective and safe in treating patients with aggressive corticotroph tumors resistant to conventional therapy. Here, we present two patients with recurrence of aggressive corticotroph pituitary tumors after surgery and radiation therapy and good response to treatment with CAP and TMZ (CAPTEM). Clinical presentation: Case 1: A 54-year-old man presented with right-sided headache and dizziness. Examination revealed palsies of the right 3rd, 4th, 5th and 6th cranial nerves. MRI confirmed a 3.6 x 3.7 x 3.5 cm sellar/suprasellar mass with right cavernous sinus invasion, chiasmal compression and clival replacement. He had transsphenoidal surgery and pathology showed a sparsely granulated ACTH adenoma with necrosis. With evidence of hypopituitarism, he was placed on prednisone, levothyroxine and testosterone. He also received stereotactic radiotherapy to manage his residual adenoma. Three years later, he presented with new onset neck pain and imaging studies showed leptomeningeal disease and biopsy confirmed ACTH adenoma. He was treated with CAPTEM for one year which resulted in clinical remission with marked radiological improvement, and persistent tumor control 20 months after cessation of therapy. Case 2: A 48 year-old man seen post transsphenoidal surgery for management of his recurrent silent corticotroph adenoma. He presented at age 21 with vision loss and had his first craniotomy. At age 31, he had repeat craniotomy for tumor recurrence that was followed by radiation therapy. With documented hypopituitarism, he has been on hydrocortisone, levothyroxine and testosterone. Although he has been legally blind, he did notice further vision loss prior to his transsphenoidal surgery. MR sella showed a 3.0 x 3.6 x 2.5 cm sellar mass infiltrating the clivus, sphenoid sinus, both cavernous sinuses and extending and compressing the optic chiasm. Even though there was good debulkment of the sellar mass, rapid tumor regrowth was noted on follow up MRI 18 months later. As the neurosurgeon did not feel that the patient would benefit from further surgery, he was treated with a year of CAPTEM. This led to significant tumor shrinkage with no tumor regrowth four months after completion of therapy. Conclusion: Our cases represent the sixth and seventh cases of CAPTEM-treated aggressive corticotroph tumors with good response to therapy. TMZ in combination with CAP seems to be promising in the management of patients with aggressive corticotroph pituitary tumors, and potentially other aggressive pituitary adenomas.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».