Adjuvant Gamma Knife radiosurgery in non-functioning pituitary adenomas; low risk of long-term complications in selected patients

Höybye, Charlotte; Rähn, T.

doi:10.1007/s11102-008-0163-x

Cited by 53 publications

(18 citation statements)

References 22 publications

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“…Stereotactic radiosurgery is a safe, viable management option for patients who receive subtotal resections and patients with recurrent nonfunctioning macroadenomas, or, less commonly, as an initial treatment for patients with high surgical comorbidities. 4,[23][24][25][26]28,33,35,37,45,[47][48][49][51][52][53]61,65 Stereotactic radiosurgery helps reduce some of the risks of conventional radiotherapy, including hypopituitarism, radiation-induced tumors, carotid stenosis, and stroke, as well as neurocognitive side effects. 1,30,38,39,56 Gamma Knife radiosurgery (GKRS) is highly effective at preventing radiographic progression of residual and recurrent adenomas.…”

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confidence: 99%

“…4,14,17,20,[23][24][25][26]28,29,33,35,37,40,41,45,[47][48][49][50][51]53,56,61,63,65 While stereotactic radiosurgery confers a high rate of tumor control (approximately 90%) and a low rate of neurological deficits, the promising results of adjuvant GKRS are largely byproducts of single-center retrospective studies. 4,17,20,[23][24][25][26]28,29,33,35,37,41,45,[47][48][49]51,55,61,65 More recently, a large-scale multicenter study proposed a strong benefit-to-risk profile of GKRS for patients with recurrent or residual growing nonfunctioning pituitary adenomas. 53 Despite such findings, a prominent challenge remains in establishing...…”

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Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

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N oNfuNctioNiNg pituitary adenomas constitute approximately 15% to 30% of pituitary tumors 10,16 and typically present with symptoms of mass effect, including vision loss, headaches, and hypopituitarism from compression of the normal pituitary gland. Selective adenomectomy via a transsphenoidal approach remains the primary treatment modality by providing decompression and the prospect for cure. Complete resection rates vary significantly and can be limited due to tumor size and propensity for microscopic invasion of the surrounding structures. 2,5,31,32,43,56 Previously reported long-term outcomes following transsphenoidal surgery for nonfunctioning macroadenomas suggest that even gross-total resection carries a 10% to 20% rate of tumor recurrence at distant follow-up. 6,8,9,13,19,21,34,43,46,58,64,66 Subtotal resection without adjuvant treatment reportedly results in the progression of adenoma growth in 50% to 60% of patients within 10 years of surgery. 9,22,34,43,46,48 For these reasons, patients with nonfunctioning tumors may undergo secondary operations and/ or adjuvant radiotherapy for the treatment of residual or progressive disease. obJective Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. methods This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. results Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. coNclusioNs Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared w...

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Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

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“…In recent decades, relatively few publications have described the results of primary GKRS for NFA. 2,9,11,20,24,28,30,32 In this study, the outcomes of initial GKRS for NFAs obtained by an international group of three centers with extensive radiosurgical experience were evaluated.…”

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Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

Lee

Kano

Yang

et al. 2014

JNS

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Object Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management. Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In this report, the authors evaluated the efficacy and safety of initial GKRS for NFAs. Methods An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs. Results Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2–25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025). Conclusions In this study, GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma.

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“…With radiotherapy and SRS adjuvant to surgery, 93%-97% local control was achieved in both functioning and non-functioning pituitary adenomas. [20][21][22] However, with these adjuvant treatments, a 50% risk of pituitary deficiency and cognitive impairment exists. 23 The role of radiotherapy in pituitary adenomas is controversial.…”

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confidence: 99%

Stereotactic Radiosurgery in Pituitary Adenomas: A Single Center Experience

Surenkok¹

2012

UHOD

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The aim of this study was to evaluate the efficiency of stereotactic radiosurgery (SRS) in the management of pituitary adenomas. Between June 1998 and July 2011, 57 patients with pituitary adenomas were treated using SRS at our department. All patients underwent high-precision single dose SRS using a linear accelerator with 6-MV photons. Median follow-up time was 31.5 (3-92) months. Median age was 40 years (range: 19-57 years). Radiological tumor growth control was achieved in 48 patients (84.2%) (a decrease in tumor size in 25 patients and no change in tumor size in 23 patients). 13 patients with functioning adenomas had available biochemical follow-up and biochemical complete response was achieved in 8 (61.5%) of these 13 patients. Treatment of pituitary adenomas using LINAC-based single dose SRS is safe and effective in improving local tumor and biochemical control. Keywords: Pituitary adenoma, Stereotactic radiosurgery, Growth hormone ÖZET Hipofiz Adenomlar›nda Stereotaktik Radyocerrahi: Tek Merkez DeneyimiBu çal›flman›n amac› stereotaktik radyocerrahi'nin hipofiz adenomu manajman›ndaki etkinli¤inin de¤erlendirilmesidir. Klini¤i-mizde Haziran 1998 ile Temmuz 2011 tarihleri aras›nda hipofiz adenomlu 57 hasta stereotaktik radyocerrahi ile tedavi edilmifltir. Tüm hastalara lineer akseleratörde 6 MV fotonlarla tek dozda yüksek hassasiyetli stereotaktik radyocerrahi uygulanm›flt›r. Medyan takip süresi 31.5 ay (s›n›rlar: 3-92 ay) idi. Radyolojik tümör büyüme kontrolü 48 hastada (84.2%) sa¤lanm›fl-t›r (25 hastada tümör boyutunda küçülme, 23 hastada tümör boyutunda de¤ifliklik yok). Biyokimyasal takibi mevcut olan fonksiyone adenomlu 13 hastadan 8'inde (%61.5) biyokimyasal tam cevap elde edilmifltir. Linak tabanl› tek doz stereotaktik radyocerrahi ile hipofiz adenomlar›n›n tedavisi lokal tümör kontrolü ve biyokimyasal kontrolün iyilefltirmesinde güven-li ve etkindir.

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Adjuvant Gamma Knife radiosurgery in non-functioning pituitary adenomas; low risk of long-term complications in selected patients

Cited by 53 publications

References 22 publications

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

Stereotactic Radiosurgery in Pituitary Adenomas: A Single Center Experience

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