Gamma Knife Radiosurgery for Nonfunctioning Pituitary Adenomas

Muacevic, A.; Uhl, Eberhard; Wowra, Berndt

doi:10.1007/978-3-7091-0583-2_5

Cited by 13 publications

(6 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most non-functioning adenomas seem to grow slowly, and we normally wait with GK treatment until a progression or a recurrence is verified, and only 4 patients, were treated prophylactically with GK within a year after surgery. Tumour growth was controlled in all tumour remnants and our results are in accordance with previous studies [1,2,4,[6][7][8][9][10][11][12][13][14], including the study by Picozzi et al [12] where radiosurgery was applied shortly after microsurgery. In five of our patients the tumour size did not change but progression was halted.…”

Section: Tumour Growth Controlsupporting

confidence: 94%

See 1 more Smart Citation

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

Höybye

Rähn

2009

Pituitary

View full text Add to dashboard Cite

Complete surgical removal of non-functioning pituitary adenomas is often not possible. This retrospective study aimed at evaluating the long-term outcome and complications of Gamma Knife (GK) radiosurgery adjuvant to pituitary microsurgery in selected patients with small tumour remnants treated 1994-2004. Thirteen men and ten women, median age 49 years, were identified. Prior to GK 15 patients had remaining pituitary function. Median size of the tumours was 1.1 cm(3). Median marginal dose was 20 Gy. Median follow-up with MR imaging was 78 and 97 months for clinical evaluation. Tumour growth control was 100%, irrespectively of growth hormone (GH) therapy for 72 months (n = 10). Only one recurrence was discovered outside radiation field and no new hypopituitarism was developed. This report suggests that in well-selected patients the long-term risk of complications is low and with careful surveillance GH insufficiency can be replaced. Lifelong follow-up is mandatory.

show abstract

Section: Tumour Growth Controlsupporting

confidence: 94%

“…GK is now used worldwide, and more than 11,000 patients with non-functioning pituitary adenomas have been treated. Previous literature has shown high control rates after treatment with GK with few complications [1,2,[4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 98%

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

Höybye

Rähn

2009

Pituitary

View full text Add to dashboard Cite

show abstract

“…In these studies, SRS was often not administered as routine postoperative adjuvant treatment but was administered only if a tumor remnant was present and growing or in case of recurrence. Nevertheless, PFS with SRS is similar to that of focal radiation therapy (FRT), being on average 90-95% at 5 years and 85-90% at 10 years (36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57). It must be noted, however, that the tumor mass in patients treated with SRS is generally smaller than in patients treated with FRT.…”

Section: Efficacy Of Radiosurgery (Srs)mentioning

confidence: 88%

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

Chanson

Dormoy

Dekkers

2019

European Journal of Endocrinology

View full text Add to dashboard Cite

Surgery is the treatment of choice for non-functioning pituitary macroadenomas (NFPAs). In cases of postoperative remnant growth or tumor recurrence, radiotherapy (RT) can be considered. The role of RT in the postoperative management of NFPAs is still debated. The main arguments against routine use of RT are the lack of randomized controlled trials, the use of clinically irrelevant endpoints in most studies on RT, the benign character of the condition, the potential for side effects of RT, and the option to apply RT at a later stage. However, because of its excellent efficacy in inhibiting tumor growth, reducing tumor volume and improving any existing visual defects, and as its side effects seem to be limited compared to the benefits provided, RT keeps a place in the management of NFPAs when a tumor remnant persists, particularly if it is invasive and displays high proliferation markers, if surveillance shows a relevant increase in tumor volume or if the tumor is close to the optic chiasm. The size of the remnant, its vicinity with the optic pathways, and the potential risk to healthy surrounding tissues need to be considered when deciding on an RT procedure.

show abstract

“…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...…”

mentioning

confidence: 99%

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

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

View full text Add to dashboard Cite

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...

show abstract

Gamma Knife Radiosurgery for Nonfunctioning Pituitary Adenomas

Cited by 13 publications

References 34 publications

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

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

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

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

Contact Info

Product

Resources

About