Endokrine und visuelle Funktion nach fraktionierter stereotaktischer Strahlenbehandlung perioptischer Tumoren

Köcher, Martin; Treuer, Harald; Hoevels, Mauritius; Semrau, R.; Sturm, Volker; Mueller, Rolf‐Peter

doi:10.1007/s00066-012-0269-y

Cited by 18 publications

(7 citation statements)

References 43 publications

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“…But we also observed an improvement of a visual disorder in 3 patients (4.1 %). These results are also in line with the data of Kocher et al [17] reporting about SRT of perioptic tumors. Regarding risk factors for occurrence of a damage of the optical system, we found both in the univariate and in the multivariate analysis, no statistically significant influence factors.…”

Section: Discussionsupporting

confidence: 93%

“…However, a single high-dose treatment may not be appropriate for large tumors or tumors adjacent to optic pathways because of the limited dose tolerance for these structures [37]. Thus, protection of optic pathways and the brain stem may be more efficiently achieved by using lower daily doses with a fractionated regime rather than SRS [17]. More recently, some reports have indicated promising outcomes with stereotactic radiotherapy (SRT) using conventional fractionation or moderate hypofractionation [5, 15, 16, 23].…”

Section: Abbreviationsmentioning

confidence: 99%

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Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas

et al. 2014

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PurposeThe purpose of this work was to evaluate a prospectively initiated two-center protocol of risk-adapted single-fraction (SRS) or fractionated radiotherapy (SRT) in patients with nonsecretory pituitary adenomas (NSA).Patients and methodsA total of 73 NSA patients (39 men/34 women) with a median age of 62 years were prospectively included in a treatment protocol of SRS [planning target volume (PTV) < 4 ccm, > 2 mm to optic pathways = low risk] or SRT (PTV ≥ 4 ccm, ≤ 2 mm to optic pathways = high risk) in two Novalis® centers. Mean tumor volume was 7.02 ccm (range 0.58–57.29 ccm). Based on the protocol guidelines, 5 patients were treated with SRS and 68 patients with SRT.ResultsMedian follow-up (FU) reached 5 years with 5-year overall survival (OS) of 90.4 % (CI 80.2–95 %) and 5-year local control and progression-free survival rates of 100 % (CI 93.3–100 %) and 90.4 % (CI 80.2–95 %), respectively. A post-SRS/SRT new visual disorder occurred in 2 patients (2.7 %), a new oculomotor nerve palsy in one pre-irradiated patient, in 3 patients (4.1 %) a pre-existing visual disorder improved. New complete hypopituitarism occurred in 4 patients (13.8 %) and in 3 patients (25 %) with pre-existing partial hypopituitarism. Pituitary function in 26 % of patients retained normal. Patients with tumor shrinkage (65.75 %) had a significantly longer FU (p = 0.0093). Multivariate analysis confirmed correlation of new hypopituitarism with duration of FU (p = 0.008) and correlation of new hypopituitarism and tumor volume (p = 0.023). No significant influence factors for occurrence of visual disorders were found.ConclusionOur SRS/SRT protocol proved to be safe and successful in terms of tumor control and protection of the visual system, especially for large tumors located close to optic pathways.

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Section: Discussionsupporting

confidence: 93%

Section: Abbreviationsmentioning

confidence: 99%

Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas

et al. 2014

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“…However, Kocher and colleagues, in another recent LINAC-FSRT series of 29 patients with perioptic tumors with a maximal total dose of 53.3 an 54.3 Gy to the optic nerves and chiasm, respectively, and maximal fractions of 1.86, reported only two new cases of disease related visual loss, but patients with short follow up were included [33]. …”

Section: Discussionmentioning

confidence: 99%

Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

et al. 2014

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To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found in four (10 %) patients with anterior skull base meningiomas and seven patients (13 %) with pituitary adenomas. The five-year actuarial freedom from 25 % RION visual field loss was 94 % following FSRT. Actuarial 2-, 5- and 10-year tumor control rates were 100, 88.4 and 64.5 % for anterior skull base meningiomas and 100, 98.2 and 94.9 % for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were systematically monitored following FSRT of benign anterior skull base tumors. Long term tumor control was favorable, especially for pituitary adenomas.

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“…Up to the present it remains unclear if considerably lower doses are equally effectivedepending on the stage of the disease. Lower total doses could reduce the potential risk for radiogenic induction of secondary tumors (Brualla et al 2013;Kocher et al 2013;Kriss et al 1989;Petersen et al 1990;Pfluger et al 1990).…”

Section: Current Recommendations On Radiotherapymentioning

confidence: 99%

Radiotherapy for Diseases of the Eye

Reinartz¹,

Pohl²

2020

Radiation Oncology

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Endokrine und visuelle Funktion nach fraktionierter stereotaktischer Strahlenbehandlung perioptischer Tumoren

Abstract: Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors.

Cited by 18 publications

References 43 publications

Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas

Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas

Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

Radiotherapy for Diseases of the Eye

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