Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Elhateer, H.S.; Muanza, Thierry; Roberge, David; Ruo, R.; Eldebawy, Eman; Lambert, Christine; Patrocinio, Horacio; Shenouda, George; Souhami, Luís

doi:10.3747/co.v15i6.293

Cited by 11 publications

(13 citation statements)

References 29 publications

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“…Our visual outcome data compare somewhat unfavorably with earlier series of tumors of the anterior skull base region treated with FSRT, with several studies reporting a low 0–6 % incidence of visual loss for meningiomas around the anterior visual pathways [ 3 , 14 – 20 ] and similarly for pituitary adenomas, in the range 0–9 % [ 2 , 21 – 29 ]. However, direct comparison with these previous studies is difficult, since median follow-up for most of them was significantly shorter [ 2 , 3 , 15 , 16 , 19 , 20 , 22 , 24 – 27 , 29 ] and several included a number of patients with less than 2 years follow up [ 2 , 16 , 20 , 22 , 24 , 26 , 27 , 29 , 30 ]. Indeed in our series, RION was in many cases a late event.…”

Section: Discussionsupporting

confidence: 81%

“…Indeed in our series, RION was in many cases a late event. More importantly, formal ophthalmological examinations were only consistently available in approximately half of the previous series [ 2 , 17 , 18 , 20 , 22 – 24 , 26 , 27 , 31 ] and only a minority of the studies reported optic radiation dose [ 2 , 17 , 18 , 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) are image-guided highly precise irradiation therapies used for tumor tissue or malformations, with the aim of maximizing the irradiation dose to the target and minimizing the dose to nearby normal tissue structures [ 1 ]. SRS/FSRT is the treatment of choice if open surgery is considered too risky; as an adjuvant treatment to surgery; when complete surgical resection is not possible or with residual or recurrent disease [ 2 ]. Also, in the case of hormone secreting pituitary tumors, FSRT may be indicated to treat hypersecretion [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, the most frequent indications for FSRT or SRS in the anterior skull base are meningiomas of the cavernous sinus and pituitary tumors with parasellar extension due to risk of cranial nerve injury and non-radicality with surgery for such lesions [ 3 ]. When choosing this treatment modality for lesions close to eloquent brain structures, it may be feasible to choose the fractionated therapy (FSRT), which combines the high accuracy of stereotactic radiation with the biological advantage of fractionation [ 1 , 2 ]. Few long-term reports on visual complications after FSRT for anterior skull base tumors exist [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…Pituitary adenomas are usually benign tumors that account for 10 - 15% of primary intracranial neoplasms[ 1 ]. Tumor growth frequently causes compression of the visual apparatus, pituitary stalk, floor of the third ventricle and enlargement of the sella turcica[ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma

et al. 2011

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PurposeTo evaluate the efficacy and toxicity of stereotactic fractionated radiotherapy (SFRT) for patients with pituitary macroadenoma (PMA).Methods and MaterialsBetween March 2000 and March 2009, 27 patients (male to female ratio, 1.25) with PMA underwent SFRT (median dose, 50.4 Gy). Mean age of the patients was 56.5 years (range, 20.3 - 77.4). In all but one patient, SFRT was administered for salvage treatment after surgical resection (transphenoidal resection in 23, transphenoidal resection followed by craniotomy in 2 and multiple transphenoidal resections in another patient). In 10 (37%) patients, the PMAs were functional (3 ACTH-secreting, 3 prolactinomas, 2 growth hormone-secreting and 2 multiple hormone-secretion). Three (11.1%) and 9 (33.3%) patients had PMA abutting and compressing the optic chiasm, respectively. Mean tumor volume was 2.9 ± 4.6 cm3. Eighteen (66.7%) patients had hypopituitarism prior to SFRT. The mean follow-up period after SFRT was 72.4 ± 37.2 months.ResultsTumor size decreased for 6 (22.2%) patients and remained unchanged for 19 (70.4%) other patients. Two (7.4%) patients had tumor growth inside the prescribed treatment volume. The estimated 5-year tumor growth control was 95.5% after SFRT. Biochemical remission occurred in 3 (30%) patients with functional PMA. Two patients with normal anterior pituitary function before SFRT developed new deficits 25 and 65 months after treatment. The 5-year survival without new anterior pituitary deficit was thus 95.8%. Five patients with visual field defect had improved visual function and 1 patient with no visual defect prior to SFRT, but an optic chiasm abutting tumor, had a decline in visual function. The estimated 5-year vision and pituitary function preservation rates were 93.2% and 95.8%, respectively.ConclusionsSFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1 patient with visual field defect out of two had an improved visual function.

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Endokrine und visuelle Funktion nach fraktionierter stereotaktischer Strahlenbehandlung perioptischer Tumoren

Köcher¹,

Treuer

Hoevels

et al. 2012

Strahlenther Onkol

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Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Cited by 11 publications

References 29 publications

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

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

Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma

Endokrine und visuelle Funktion nach fraktionierter stereotaktischer Strahlenbehandlung perioptischer Tumoren

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