Four Years’ Experiences in the Treatment of Pituitary Adenomas with Gamma Knife Radiosurgery

Abstract

To determine the tumor control rates and endocrinological responses after stereotactic radiosurgery for pituitary adenomas, we reviewed our experience in 65 patients (40 men, 25 women) treated in the Gamma Knife during the last 4 years. The mean age was 41.6 years (range 19–69 years). 43 patients had endocrinologically active tumors (20 growth hormone-secreting, 19 prolactin-secreting and 4 ACTH-secreting adenomas). 22 had nonfunctioning adenomas. 39 patients had a macroadenoma and 26 patients had a microadenoma. 33 patients underwent Gamma Knife radiosurgery for recurrent or residual tumors after microsurgery. 50 patients have had follow-up neuroimaging studies and/or hormonal evaluation. The follow-up period was 25.5 months (range 3 to 54 months). The margin of the tumor was incorporated within the 50 to 90% isodose. The mean number of isocenters was 3.8 and the mean marginal dose was 25.4 Gy (range 15 to 36 Gy). 27 out of 40 patients (65.7%) showed decreased tumor volume to less than 50% of the initial volume. In 17 out of 38 patients (44.7%) with endocrinologically active tumors, the hormonal level fell to within the normal range. Two patients had delayed complications: in one case there was pituitary insufficiency and in the other a visual disturbance. Gamma Knife radiosurgery seems to be effective adjuvant therapy for pituitary adenoma in selected cases. More long-term follow-up is required to evaluate the efficacy and side effects further.

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

“…Despite the proximity of the optic apparatus to the pituitary gland, only 10 case series 5,7,13,17,18,25,32,44,58,62 in our analysis reported postradiosurgical visual complications, with Kobayashi et al 25 demonstrating the highest incidence at 11%. The low rate of visual complications following SRS likely stems from each group's attempt to limit the dose received by the optic apparatus to 8-10 Gy.…”

A systematic analysis of disease control in acromegaly treated with radiosurgery

“…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.…”

Radiation therapy in the treatment of pituitary tumors

“…11,14,24,36,43,44,46,47,51 The optic neuropathies were thought to have occurred with estimated doses of 0.7-12 Gy. 50 Most investigators have chosen an upper limit of 8 48 to 12 51 Gy as a safe radiation dose to the optic nerve, and a clearance of 2 5,51 to 5 43,44 mm of the optic nerve away from the tumor is preferred.…”