Heavy-Charged-Particle Radiosurgery of the Pituitary Gland: Clinical Results of 840 Patients

Levy, Richard P.; Fabrikant, Jacob I.; Frankel, Kenneth A.; Phillips, Mark H.; Lyman, John; Lawrence, John H.; Tobias, Cornelius A.

doi:10.1159/000099553

Cited by 121 publications

(46 citation statements)

References 11 publications

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“…The limited data on the use of gamma knife surgery (GKS) in Nelson's syndrome are conflicting (78)(79)(80)(81). Although one study of Nelson's syndrome patients showed no tumour re-growth at 7 years post GKS therapy (82), a further study showed remission rates post GKS to be only 14% (83).…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Nelson's syndrome

Barber

Adams²,

Ansorge³

et al. 2010

European Journal of Endocrinology

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Nelson's syndrome is a potentially life-threatening condition that does not infrequently develop following total bilateral adrenalectomy (TBA) for the treatment of Cushing's disease. In this review article, we discuss some controversial aspects of Nelson's syndrome including diagnosis, predictive factors, aetiology, pathology and management based on data from the existing literature and the experience of our own tertiary centre. Definitive diagnostic criteria for Nelson's syndrome are lacking. We argue in favour of a new set of criteria. We propose that Nelson's syndrome should be diagnosed in any patient with prior TBA for the treatment of Cushing's disease and with at least one of the following criteria: i) an expanding pituitary mass lesion compared with pre-TBA images; ii) an elevated 0800 h plasma level of ACTH (O500 ng/l) in addition to progressive elevations of ACTH (a rise of O30%) on at least three consecutive occasions. Regarding predictive factors for the development of Nelson's syndrome post TBA, current evidence favours the presence of residual pituitary tumour on magnetic resonance imaging (MRI) post transsphenoidal surgery (TSS); an aggressive subtype of corticotrophinoma (based on MRI growth rapidity and histology of TSS samples); lack of prophylactic neoadjuvant pituitary radiotherapy at the time of TBA and a rapid rise of ACTH levels in year 1 post TBA. Finally, more studies are needed to assess the efficacy of therapeutic strategies in Nelson's syndrome, including the alkylating agent, temozolomide, which holds promise as a novel and effective therapeutic agent in the treatment of associated aggressive corticotroph tumours. It is timely to review these controversies and to suggest guidelines for future audit.

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Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Nelson's syndrome

Barber

Adams²,

Ansorge³

et al. 2010

European Journal of Endocrinology

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“…There are relatively few studies detailing the results of radiosurgery for Nelson's syndrome (Table 6) ( Ganz, 2000;Ganz et al, 1993;Kobayashi et al, 2002;Laws & Vance, 1999;Levy et al, 1991;Mauermann et al, 2007;Pollock & Wolffenbuttel et al, 1998;Young, 2002). These studies report a mean tumor dose from between 12 Gy to 28.7 Gy, and an endocrine remission rate ranging from 0% to 36%, although only a minority of these studies defined what was meant by endocrine remission.…”

Section: Rsxmentioning

confidence: 99%

Stereotactic Radiosurgery for Pituitary Adenomas

Brau¹,

Lozada²

2012

Pituitary Adenomas

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“…This method of irradiation was widely used for treatment of acromegaly in the 1960s and 1970s. 33,45,56 Its popularity, however, waned as more advanced technologies, such as GKS, were optimized for less frequent side effects. 6,59,83 Still, interest in this modality remains, and the treatment continues to be studied at the 7 proton beam centers in the US.…”

Section: Proton-beam Radiosurgerymentioning

confidence: 99%

“…2,56,97 Since that time, substantial advances in radiation technology have yielded increasingly precise pituitary adenoma-targeting capability and consequently an expanded set of treatment options for acromegaly to supplement resection and hormonal suppression with medical management. A complex array of factors dictate treatment decisions for acromegaly in the modern era, including adenoma size, degree of secretory hyperactivity, invasion of surrounding structures, and therapeutic side effects and their particular impact in the patient in question.…”

mentioning

confidence: 99%

Radiation treatment strategies for acromegaly

Rowland

Aghi²

2010

FOC

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The high morbidity and mortality associated with acromegaly can be addressed with multiple treatment modalities, including surgery, medicines, and radiation therapy. Radiation was initially delivered through conventional fractionated radiotherapy, which targets a wide area over many treatment sessions and has been shown to induce remission in 50%–60% of patients with acromegaly. However, conventional fractionated radiotherapy takes several years to achieve remission in patients with acromegaly and carries a risk of hypopituitarism that may limit its use. Stereotactic radiosurgery, of which there are several forms, including Gamma Knife surgery, CyberKnife therapy, and proton beam therapy, offers slightly attenuated efficacy but achieves remission in less time and provides more precise targeting of the adenoma with better control of the dose of radiation received by adjacent structures such as the pituitary stalk, pituitary gland, optic chiasm, and cranial nerves in the cavernous sinus. Of the forms of stereotactic radiosurgery, Gamma Knife surgery is the most widely used and, because of its long-term follow-up in clinical studies, is the most likely to compete with medical therapy for first-line adjuvant use after resection. In this review, the authors outline the major modes of radiation therapies in clinical use today, and they critically assess the feasibility of these modalities for acromegaly treatment. Acromegaly is a multisystem disorder that demands highly specialized treatment protocols including neurosurgical and endocrinological intervention. As more efficient forms of pituitary radiation develop, acromegaly treatment options may continue to change with radiation therapies playing a more prominent role.

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Heavy-Charged-Particle Radiosurgery of the Pituitary Gland: Clinical Results of 840 Patients

Cited by 121 publications

References 11 publications

Nelson's syndrome

Nelson's syndrome

Stereotactic Radiosurgery for Pituitary Adenomas

Radiation treatment strategies for acromegaly

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