A Six Year Experience with the Postoperative Radiosurgical Management of Pituitary Adenomas

Mokry, Michael; Ramschak-Schwarzer, Sigrid; Simbrunner, J.; Ganz, Jeremy C.; Pendl, G.

doi:10.1159/000056444

Cited by 99 publications

(60 citation statements)

References 17 publications

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“…1,7,8,10,16,19,22,23,[25][26][27][28]30,33,34,[37][38][39][40][41][42]45,[47][48][49]51 The mean reported patient age was 45.2 ± 3.78 years. The overall mean duration of reported follow-up was 48.5 ± 25.8 months, and the overall median duration of reported follow-up was a similar 46.6 ± 20.4 months.…”

Section: Results Of Systematic Analysismentioning

confidence: 98%

A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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Object Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone–secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly. Methods A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication. Results The overall disease control rate without medication was 48%–53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 ± 25.8 months. The mean overall tumor volume in this analysis was 2.11 ± 1.16 cm3. The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546). Conclusions Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly.

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Section: Results Of Systematic Analysismentioning

confidence: 98%

A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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“…For patients in whom radiosurgery is not completely curative, additional medical therapy can offer hormonal normalization in roughly 32% of patients, according to the series in our analysis. 2,5,8,12,16,17,33,39,44,47,48,53,54,58,59 In addition to rates of hormonal cure of 17% to 82% following SRS, the mean rate of tumor growth control was more than 97% across the patient series (Table 2). Just as several studies demonstrated that endocrinological normalization increases with time, Mokry et al 39 reported that tumor volumes progressively decline following SRS.…”

Section: Discussionmentioning

confidence: 99%

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stapleton

Liu

Weiss

2010

FOC

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Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

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“…The evaluation of GKR effect on hormone levels has varied greatly among publications, and comparisons are therefore difficult. We reviewed 10 studies encompassing altogether 302 GKR-treated acromegaly patients, where criteria for cure were both normalization of IGF-I and a stated cut-off level for GH (7,10,(12)(13)(14)(15)(16)(17)(18)35; Table 5). The cut-off GH values varied between 2 and 7 mg/l, and cure rates between 20 and 100%.…”

Section: Disease Controlmentioning

confidence: 99%

“…GKR is assumed to reduce hypersecretion more rapidly than CRT, whilst keeping the adverse effects at a low level (5,6), but the number of patients reported is altogether low and the definition criteria for endocrine cure and hypopituitarism vary greatly between studies, making comparison difficult (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The elapsed time from when GKR treatment is given until full effect is obtained is several years, and in many series the follow-up time is short.…”

Section: Introductionmentioning

confidence: 99%

Gamma knife stereotactic radiosurgery for acromegaly

Vik-Mo¹,

Øksnes²,

Pedersen³

et al. 2007

eur j endocrinol

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Background: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion. Objective: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment. Design: Cross-sectional follow-up study. First, retrospective data pre-and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. Setting: Norwegian National Center for gamma knife treatment. Patients: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up. Results: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period. Conclusion: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.

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A Six Year Experience with the Postoperative Radiosurgical Management of Pituitary Adenomas

Cited by 99 publications

References 17 publications

A systematic analysis of disease control in acromegaly treated with radiosurgery

A systematic analysis of disease control in acromegaly treated with radiosurgery

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Gamma knife stereotactic radiosurgery for acromegaly

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