Gamma Knife Radiosurgery for Pituitary Adenomas

Hayashi, Motohiro; Izawa, Masahiro; Hiyama, Hirofumi; Nakamura, Sayaka; Atsuchi, Shoko; Sato, Hikari; Nakaya, K.; Sasaki, Kazuhumi; Ochiai, Taku; Kubo, Osami; Hori, Tomokatsu; Takakura, Kintomo

doi:10.1159/000056446

Cited by 92 publications

(57 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Adverse Effectsmentioning

confidence: 54%

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

Stapleton

Liu

Weiss

2010

FOC

View full text Add to dashboard Cite

Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

show abstract

Section: Adverse Effectsmentioning

confidence: 54%

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

Stapleton

Liu

Weiss

2010

FOC

View full text Add to dashboard Cite

show abstract

“…The reported tumour control in SRS studies in patients with Cushing's disease was 94% at a corrected median follow-up of 45 months (table 2) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). This compares to the 5-year tumour control rate (progression free survival) in all pituitary adenomas of 91.5% (39)(40)(41)(42), which is worse than reported following fractionated RT even though the tumours treated are smaller.…”

Section: Radiosurgerymentioning

confidence: 78%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease. RESUMORadioterapia e Radiocirurgia para a Doença de Cushing. Pacientes com doença de Cushing residual ou recorrente recebem radioterapia externa em feixe (RT) com o objetivo de alcançar um controle tumoral prolongado e a normalização dos níveis hormonais elevados. O tratamento é realizado tanto com RT convencional, usando técnicas conformacionais, ou com RT estereotáxica, que é usada tanto como tratamento fracionado (RTF) ou como radiocirurgia em procedimento único (RCU). Descreveremos os aspectos técnicos do tratamento e mostraremos uma revisão sistemática da literatura sobre a eficácia e toxicidade da RT convencional, da RTF e da RCU. Não existem estudos comparando diretamente as diferentes técnicas de radiação, e os resultados reportados são inevitavelmente os de pacientes selecionados pelos investigadores com interesse no tratamento testado. De qualquer maneira, a revisão dos dados publicados sugere que há melhores taxas de controle hormonal e tumoral após RTF em comparação com RCU. O hipopituitarismo representa a complicação tardia mais comumente relatada da RT, vista após todos os tipos de tratamento. Embora a incidência de outros efeitos tardios seja baixa, o risco de a radiação comprometer estrutura...

show abstract

“…Many studies reported a greater than 95% control of tumor size with follow-up varying from months to years [2,6]. Izawa et al, 2000, after mean follow up of 24 months in 79 secretory pituitary adenoma patients treated with GKS, reported local tumor control in 93.6% of patients, with reduction in 24.1%, they prescribed a mean marginal dose of 22.5Gy [13].…”

Section: Discussionmentioning

confidence: 99%

Gamma knife surgery in management of secretory pituitary adenoma preliminary evaluation of role, efficacy and safety

Hafez¹,

Morgan²,

Fahmy³

2014

Neurosci Discov

View full text Add to dashboard Cite

Historically the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, fractionated radiotherapy and recently gamma knife surgery (GKS), the goal of this study is to evaluate the efficacy, safety and role of gamma knife surgery for treatment of secretory pituitary adenomas regarding hormonal and adenoma size control, between mid of 2005 and 2012 a retrospective analysis of 54 consecutive patients with secretory pituitary adenomas underwent GKS at the International Medical Center (IMC) Cairo-Egypt, 10 patients with adrenocorticotrophic hormone secreting adenoma, 24 prolactin secreting adenoma and 20 with growth hormone secreting adenoma, in 25 patients GKS was the secondary to a prior surgery with failure of hormonal control even in addition of medical treatment, in the other 29 the secretory pituitary adenomas not controlled with medical treatment alone, the median follow up period was 28 months(12-84 months), achieving hormonal control was either normalization or marked decline of abnormal hormone level >50%, radiological tumour size control was either tumour size stabilization or reduction, among the 54 patients 31 had microadenoma of 1cc volume or less, over all 34 patients (63%) had hormonal control and 51 patients (94%) had tumor size control after GKS, there was a direct correlation between tumor size, prescription radiation dose and post-gamma knife hormonal and size control, 29 out of the treated 31 microadenomas cases showed both hormonal and size control, inconclusions gamma knife surgery is safe and effective treatment for secretory pituitary adenomas failed to respond to medical treatment alone or with postsurgical residual or recurrence especially microadenomas.

show abstract

Gamma Knife Radiosurgery for Pituitary Adenomas

Cited by 92 publications

References 9 publications

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

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

Radiotherapy and radiosurgery for Cushing's disease

Gamma knife surgery in management of secretory pituitary adenoma preliminary evaluation of role, efficacy and safety

Contact Info

Product

Resources

About