A systematic review of stereotactic radiosurgery for pituitary metastases

TL;DR

This paper reviews the use of stereotactic radiosurgery for treating rare pituitary metastases, finding high local tumor control but limited survival.

Contribution

The study provides a systematic review of stereotactic radiosurgery outcomes for pituitary metastases, highlighting local control and endocrine outcomes.

Findings

Stereotactic radiosurgery achieved a pooled local control rate of 90% in pituitary metastases.

Median survival was 14 months, with endocrine function and cranial nerve deficits showing stability or improvement in most patients.

Dose to the optic apparatus was under 10 Gy in 85.7% of cases, suggesting potential for preserving vision.

Abstract

Pituitary gland metastases (PGM) are extremely rare, and their ideal management is poorly defined. Radiosurgery for PGM may obviate the need for tumor excision, decreasing surgical morbidity in a patient population with an otherwise life-limiting illness. Given this, we sought to summarize existing literature on outcomes of PGM treated with stereotactic radiosurgery (SRS).

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). PubMed and Science Direct databases were queried from their inception through November 2025. The search phrase “((Stereotactic radiosurgery OR SRS OR radiosurgery) AND (Pituitary metastases))” was applied without any search filters. The primary outcome of interest was local tumor control (LC) with an aggregate local tumor control (LC) point estimate derived by calculating a weighted average across selected studies. Additional outcomes of interest were, post-SRS endocrinological function, and cranial nerve deficits.

Eight studies encompassing 119 patients with PGM treated with SRS were reviewed. A median tumor volume and diameter of 2.35 cm3, and 2.2 cm respectively was treated with a median prescription dose of 13.0 Gy. The dose delivered to the optic apparatus was <10 Gy in 85.7% of studies. The pooled local control rate following SRS was 90% (95% CI: 75%-99%) over a median follow up of 7 months. A pooled median survival estimate of 14 months (range: 5.2-30.0) was demonstrated. Diabetes insipidus, hypopituitarism, and cranial nerve deficits either improved or were stable following SRS in 50.0%, 53.6%, and 75.0% of patients respectively.

SRS affords high LC in the setting of PGM. Despite this, survival is poor and likely depends on systemic disease control. A multidisciplinary approach incorporating SRS represents a promising option for this patient population. Further characterization of optimal radiosurgical parameters is warranted.

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