Gamma surgery in the treatment of nonsecretory pituitary macroadenoma

Mingione, Vincenzo; Yen, Chun Po; Vance, Mary Lee; Steiner, Melita; Sheehan, Jason P.; Laws, Edward R.; Steiner, Ladislau

doi:10.3171/jns.2006.104.6.876

Cited by 129 publications

(65 citation statements)

References 58 publications

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“…As noted in our series of nonsecretory pituitary adenomas, with a long follow-up period, parasellar meningiomas tended to either decrease or increase compared with being unchanged in volume. 39 Cranial nerve palsies occurred in 14 (10%) of the 138 patients treated, which is consistent with previously published reports that cite cranial nerve deficits between 0% and 10% (Table 4). Factors associated with the development of cranial nerve deficits included larger tumor volume, lower peripheral radiation dose, lower maximum radiation dose, tumor progression, and longer follow-up duration.…”

Section: Discussionsupporting

confidence: 81%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

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Object. Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.Methods. The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19-85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2-54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.Results. The mean follow-up duration was 84 months (median 75.5 months, range 24-216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.Conclusions. Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose. (DOI: 10.3171/2011.1.JNS091939) keY WorDs • stereotactic radiosurgery • parasellar meningioma • skull base • cavernous sinus 1571Abbreviations used in this paper: GKS = Gamma Knife surgery; PFS = progression-free survival.

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Section: Discussionsupporting

confidence: 81%

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Williams¹,

Yen²,

Starke³

et al. 2011

JNS

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“…Older fractionated radiotherapy series have reported incidences of new endocrinopathy ranging from 25% to 40%. 17,20,37,49 However, more recent multicenter radiosurgery series have reported a lower incidence of new or worsened hypopituitarism after radiosurgery that is closer to 20%, with thyroid and cortisol deficiencies reported as the most common postradiosurgical endocrinopathies. 53 Given the high incidence of adenoma progression after subtotal resection over time and the efficacy of radiosurgery for preventing tumor progression with a relatively low incidence of new endocrinopathy, the present study examines the potential utility of GKRS performed shortly after transsphenoidal surgery.…”

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confidence: 99%

“…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...…”

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confidence: 99%

“…Stereotactic radiosurgery is a safe, viable management option for patients who receive subtotal resections and patients with recurrent nonfunctioning macroadenomas, or, less commonly, as an initial treatment for patients with high surgical comorbidities. 4,[23][24][25][26]28,33,35,37,45,[47][48][49][51][52][53]61,65 Stereotactic radiosurgery helps reduce some of the risks of conventional radiotherapy, including hypopituitarism, radiation-induced tumors, carotid stenosis, and stroke, as well as neurocognitive side effects. 1,30,38,39,56 Gamma Knife radiosurgery (GKRS) is highly effective at preventing radiographic progression of residual and recurrent adenomas.…”

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

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

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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...

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“…Tumor control rates for nonfunctioning pituitary adenomas were 87% to 97%, and the rates of new hormone deficit were 6.5% to 25% by application of margin doses of 14 to 18.5 Gy. 40,73,85,102,105) Several series of stereotactic radiosurgery for acromegaly patients showed that tumor volume control rates were 97% to 100%, insulin-like growth factor-1 normalization rates were 23% to 60% with margin doses of 15 to 27 Gy, and new hormone deficits and visual complication was observed in 12% to 34% and 0% to 4%, respectively. 41,72,108,142) In Cushing's disease, endocrine remission rates ranged from 17% to 83%.…”

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 surgery in the treatment of nonsecretory pituitary macroadenoma

Cited by 129 publications

References 58 publications

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival

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

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

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