Gamma-Knife Surgery for Secreting Pituitary Adenomas

Morange-Ramos, I; Régis, Jean; Dufour, Henry; Andrieu, J. M.; Grisoli, F; Jaquet, P; Peragut, J. C.

doi:10.1007/s007010050121

Cited by 91 publications

(48 citation statements)

References 14 publications

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“…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.…”

Section: Results Of Systematic Analysismentioning

confidence: 98%

A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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Object Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone–secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly. Methods A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication. Results The overall disease control rate without medication was 48%–53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 ± 25.8 months. The mean overall tumor volume in this analysis was 2.11 ± 1.16 cm3. The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546). Conclusions Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly.

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Section: Results Of Systematic Analysismentioning

confidence: 98%

A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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“…Only a few papers addressed the topic of RxT results in acromegaly using these criteria, stressing the normalization of IGF-I as well as lowering of GH levels. While some reports showed a good reduction of IGF-I, with RxT success rate ranging from 47 to 96% (15,17), others reported more disappointing results, showing IGF-I normalization in less than 20% of their series (19,20).…”

Section: Discussionmentioning

confidence: 95%

“…Five patients (nos 12,20,28,32,38) had been lost to follow-up, i.e. the last evaluation had been performed more than 3 years ago.…”

Section: Follow-upmentioning

confidence: 99%

Failure of radiotherapy in acromegaly

Cozzi¹,

Barausse²,

Asnaghi

et al. 2001

European Journal of Endocrinology

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Background: Recent data has raised skepticism regarding the long-term effectiveness of radiotherapy (RxT) in acromegaly and its role as an ancillary tool to neurosurgery (Tx). Patients: We evaluated 72 acromegalic patients previously submitted to RxT. Data were discarded in 23 patients, who were lost to follow-up, operated on after RxT or irradiated with techniques different from external conventional fractionated RxT. Among the remaining 49 (five with mixed GH-prolactin adenoma), 34 were irradiated after surgical failure and 15 as primary treatment. A second cycle of RxT was administered in two. Results: (i) GH/IGF-I. After a median follow-up of 14 years (range 3-41), normal age-matched IGF-I levels were reached in eight patients (16%) after 10 years, and GH levels ,2.5 mg/l in six (12%) after 9 years. The rate of persistently pathological hormonal levels was still 90% at 25 years. All patients with GH/IGF-I normalization had undergone irradiation without any antisecretory drug. Neither basal GH nor tumor size affected the outcome of RxT. In three patients (6%) a relapse/worsening occurred. (ii) Tumor size. Tumor shrank after 8.5 years in 24 patients (49%), in nine of whom during GH-suppressive treatment. Tumor shrinkage was not predictive of hormonal normalization. (iii) Side-effects. Hypopituitarism was diagnosed in four patients (selective in three and global in one) and GH deficiency in one. Three patients had neurological side-effects and meningioma was shown in two patients. Conclusion: RxT is unable to cure acromegaly, because it seldom achieves hormonal normalization even after a very prolonged follow-up. Concomitant antisecretory treatment seems to counteract its effects. RxT can still play a role in those patients with large tumor remnants, because of its capacity to shrink tumor size.

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“…41,72,108,142) In Cushing's disease, endocrine remission rates ranged from 17% to 83%. 41,74,86) Although radiosurgery for pituitary adenomas achieved tumor growth control in most patients, oversecretion of hormone by functioning adenomas is still difficult to control only by stereotactic radiosurgery. Combination of surgery and/or medication with radiosurgery is necessary for these diseases.…”

Section: Benign Tumorsmentioning

confidence: 99%

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

Koga

Shin

Saito

2010

Neurol. Med. Chir.(Tokyo)

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The gamma knife was the first radiosurgical device developed at the Karolinska Institute in 1967. Stereotactic radiosurgery using the gamma knife has been widely accepted in clinical practice and has contributed to the development of neurosurgery. More than 500,000 patients have been treated by gamma knife stereotactic radiosurgery so far, and the method is now an indispensable neurosurgical tool. Here we review long-term outcomes and development of stereotactic radiosurgery using the gamma knife and discuss its future perspectives. The primary role of stereotactic radiosurgery is to control small well-demarcated lesions such as metastatic brain tumors, meningiomas, schwannomas, and pituitary adenomas while preserving the function of surrounding brain tissue. The gamma knife has been used as a primary treatment or in combination with surgery, and some applications have been accepted as standard treatment in the field of neurosurgery. Treatment of cerebral arteriovenous malformations has also been drastically changed after emergence of this technology. Controlling functional disorders is another role of stereotactic radiosurgery. There is a risk of radiation-induced adverse events, which are usually mild and less frequent. However, especially in large or invasive lesions, those risks are not negligible and pose limitations. Advancement of irradiation technology and dose planning software have enabled more sophisticated and safer treatment, and further progress will contribute to better treatment outcomes not only for brain lesions but also for cervical lesions with less invasive treatment.

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Gamma-Knife Surgery for Secreting Pituitary Adenomas

Cited by 91 publications

References 14 publications

A systematic analysis of disease control in acromegaly treated with radiosurgery

A systematic analysis of disease control in acromegaly treated with radiosurgery

Failure of radiotherapy in acromegaly

Role of Gamma Knife Radiosurgery in Neurosurgery: Past and Future Perspectives

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