Pituitary Tumors Clinical Trial
Official title:
Identification of GENEtic Markers of Aggressiveness and Malignancy by Array Comparative Genomic Hybrization Analysis (CGH)
Recent studies estimate that the prevalence of pituitary adenomas is approximately 1/1500
persons. Pituitary tumours are usually considered as benign. However, local invasion is
reported in 35-40% of pituitary adenomas; resistance to medical treatment or recurrence
leading to multimodal therapy is reported in about 15% of cases. These tumours are
considered as aggressive pituitary tumours and present a distinct biological and clinical
entity with continued growth despite multimodal therapy, including surgery and radiotherapy
(McCormack et al., 2011). Whilst these tumours have malignant potential, the term of
pituitary carcinoma is strictly reserved for those rare tumours (0.2%) with demonstrated
craniospinal or systemic metastases (Heaney, 2011).
Pituitary aggressive and malignant tumours are very difficult to control and ultimately
prove to be lethal. It was suggested that early aggressive treatments (chemotherapy,
radiotherapy) may control progression and occurrence of metastases. However, these
therapeutic options are associated with important side effects limiting their use and the
prediction of pituitary tumor behaviour remains a challenge. At the diagnosis, clinical
signs are not specific and the results concerning proliferative factors (Ki-67 and P53),
putative oncogenes (PTTG) conflict from one series to another.
In a case-control retrospective study of a cohort of 410 patients (HYPOPRONOS), we validated
a prognostic pathological classification based on histological and radiological data (J.
Trouillas 2012 in preparation). Tumours were classified into 3 grades: grade 1= non-invasive
tumour, grade 2= invasive tumour and grade 3 = aggressive-invasive tumor with the
combination of radiological signs of invasion and 2 of 3 signs of increased proliferation
(Ki-67 index>3%, number of mitoses>2 per 10 fields at 400X, P53 nuclear detection).
It is now widely accepted that cancer is a clonal disease, which arises from a single normal
cell and progresses thanks to the accumulation of DNA alterations (Sanson et al., 2011). To
identify the role of these DNA alterations, we conducted array CGH analysis limited to 13
prolactin pituitary tumours, from frozen fragments, and identified allelic loss of
chromosome 11 associated with aggressiveness and malignancy (Wierinckx et al., 2011).
To confirm these encouraging results we propose to conduct a study on a large series of
tumours, fixed and embed, and to be correlated the results to clinical data.
n/a
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