Hypopituitarism after gamma knife radiosurgery for pituitary adenoma

Tomšić, Karin Zibar; Dušek, Tina; Kraljević, Ivana; Heinrich, Zdravko; Solak, Mirsala; Vučinović, Ana; Ozretić, David; Marasanov, Sergej; Hršak, Hrvoje; Kaštelan, Darko

doi:10.1080/07435800.2017.1323913

Cited by 19 publications

(8 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anterior pituitary insufficiency, estimated to occur in 18% to 50% of patients, is the most frequent intermediate-to-late complication after SRS for pituitary adenomas. 9,[11][12][13]18 SRS is a frequently used upfront, adjuvant, or salvage treatment for pituitary adenomas, and targeting modifiable risk factors for anterior pituitary insufficiency is important to optimize patient outcomes. 4,19 At our institution, among patients with nonfunctioning and functioning pituitary adenoma treated with SRS from 2007 to 2020, we previously found an independent association between the distance from the center of the normal pituitary gland to the center of the tumor isodose and anterior pituitary function preservation.…”

Section: Discussionmentioning

confidence: 99%

Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study

Ironside

Chen

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND:Delayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas.OBJECTIVE:To investigate the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study.METHODS:We retrospectively reviewed the International Radiosurgery Research Foundation database from January 2002 to December 2021 for adult patients undergoing SRS for pituitary adenomas with >6 months of follow-up. Distances between centers or edges of hypothalamic-pituitary axis structures and SRS target volumes were measured using MRI. The primary outcome was anterior pituitary function preservation. Predictors were analyzed using multivariable logistic regression and area under the receiver operating curve (AUROC) curve analyses.RESULTS:Four hundred eighty-seven patients were categorized by preservation (n = 384) and no preservation (n = 103) of anterior pituitary function. The mean margin dose was 19.1(6.2) Gy. Larger distance from the center of the stalk to the tumor margin isodose was a positive predictor (adjusted odds ratio [aOR] = 1.162 [1.046-1.291], P = .005), while pre-SRS hypopituitarism (aOR = 0.646 [0.405-1.031], P = .067) and larger treatment volume (aOR = 0.965 [0.929-1.002], P = .061) were near negative predictors of the primary outcome. An interaction between the treatment volume and center stalk to margin isodose distance was found (aOR = 0.980 [0.961-0.999], P = .045). Center stalk to margin isodose distance had an AUROC of 0.620 (0.557-0.693), at 3.95-mm distance. For patients with treatment volumes of <2.34 mL, center stalk to margin isodose distance had an AUROC of 0.719 (0.614-0.823), at 2.95-mm distance.CONCLUSION:Achieving a distance between the center of the pituitary stalk and the tumor margin isodose ≥3.95 mm predicted anterior pituitary function preservation. For smaller treatment volumes <2.34 mL, the optimal distance was ≥2.95 mm. This may be modifiable during trans-sphenoidal resection to preserve pituitary function.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study

Ironside

Chen

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

show abstract

“…However, few studies directly assessed the outcomes of the adenohypophysis in accordance with the change characteristics of the perioperative hormonal level in NFPAs. In these studies, male and female hormones were generally pooled for assessment (3,17,18). Significant differences in hormonal levels were found between men and women.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the other hormones of the anterior pituitary are considered as important factors for individual hormonal outcomes. The assessment of the whole pituitary hormones could accurately predict the remnant pituitary function after surgery (17). Several limitations warrant further discussion.…”

Section: Predictive Models For Postoperative Hypopituitarismmentioning

confidence: 99%

Machine-Learning Prediction of Postoperative Pituitary Hormonal Outcomes in Nonfunctioning Pituitary Adenomas: A Multicenter Study

et al. 2021

View full text Add to dashboard Cite

ObjectiveNo accurate predictive models were identified for hormonal prognosis in non-functioning pituitary adenoma (NFPA). This study aimed to develop machine learning (ML) models to facilitate the prognostic assessment of pituitary hormonal outcomes after surgery.MethodsA total of 215 male patients with NFPA, who underwent surgery in four medical centers from 2015 to 2021, were retrospectively reviewed. The data were pooled after heterogeneity assessment, and they were randomly divided into training and testing sets (172:43). Six ML models and logistic regression models were developed using six anterior pituitary hormones.ResultsOnly thyroid-stimulating hormone (p < 0.001), follicle-stimulating hormone (p < 0.001), and prolactin (PRL; p < 0.001) decreased significantly following surgery, whereas growth hormone (GH) (p < 0.001) increased significantly. The postoperative GH (p = 0.07) levels were slightly higher in patients with gross total resection, but the PRL (p = 0.03) level was significantly lower than that in patients with subtotal resection. The optimal model achieved area-under-the-receiver-operating-characteristic-curve values of 0.82, 0.74, and 0.85 in predicting hormonal hypofunction, new deficiency, and hormonal recovery following surgery, respectively. According to feature importance analyses, the preoperative levels of the same type and other hormones were all important in predicting postoperative individual hormonal hypofunction.ConclusionFluctuation in anterior pituitary hormones varies with increases and decreases because of transsphenoidal surgery. The ML models could accurately predict postoperative pituitary outcomes based on preoperative anterior pituitary hormones in NFPA.

show abstract

“…Gamma Knife radiosurgery (GKRS) which has advantages of a highly precise, better dose conformity and focused delivery of radiation in a single session, is one of the best radiation technique and essential part in the treatment of pituitary tumors. As previous publications reported (4)(5)(6)(7)(8)(9)(10)(11)(12), GKRS has been proved to offer a high tumor control rate of 83-95% and a low new-onset hypopituitarism rate of 9-32% for pituitary adenomas. Treatment failure after GKRS for NFPAs consists of progressive cystic enlargement, tumor apoplexy and tumor regrowth (4).…”

Section: Introductionmentioning

confidence: 87%

Characteristic of Tumor Regrowth After Gamma Knife Radiosurgery and Outcomes of Repeat Gamma Knife Radiosurgery in Nonfunctioning Pituitary Adenomas

Li¹,

Wu²,

Quan³

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

ObjectiveThis study aimed to report the characteristic of tumor regrowth after gamma knife radiosurgery (GKRS) and outcomes of repeat GKRS in nonfunctioning pituitary adenomas (NFPAs).Design and MethodsThis retrospective study consisted of 369 NFPA patients treated with GKRS. The median age was 45.2 (range, 7.2–84.0) years. The median tumor volume was 3.5 (range, 0.1–44.3) cm3.ResultsTwenty-four patients (6.5%) were confirmed as regrowth after GKRS. The regrowth-free survivals were 100%, 98%, 97%, 86% and 77% at 1, 3, 5, 10 and 15 year, respectively. In multivariate analysis, parasellar invasion and margin dose (<12 Gy) were associated with tumor regrowth (hazard ratio [HR] = 3.125, 95% confidence interval [CI] = 1.318–7.410, p = 0.010 and HR = 3.359, 95% CI = 1.347–8.379, p = 0.009, respectively). The median time of regrowth was 86.1 (range, 23.2–236.0) months. Previous surgery was associated with tumor regrowth out of field (p = 0.033). Twelve patients underwent repeat GKRS, including regrowth in (n = 8) and out of field (n = 4). Tumor shrunk in seven patients (58.3%), remained stable in one (8.3%) and regrowth in four (33.3%) with a median repeat GKRS margin dose of 12 (range, 10.0–14.0) Gy. The actuarial tumor control rates were 100%, 90%, 90%, 68%, and 68% at 1, 3, 5, 10, and 15 years after repeat GKRS, respectively.ConclusionsParasellar invasion and tumor margin dose (<12 Gy) were independent risk factors for tumor regrowth after GKRS. Repeat GKRS might be effective on tumor control for selected patients. For regrowth in field due to relatively insufficient radiation dose, repeat GKRS might offer satisfactory tumor control. For regrowth out of field, preventing regrowth out of field was the key management. Sufficient target coverage and close follow-up might be helpful.

show abstract

Hypopituitarism after gamma knife radiosurgery for pituitary adenoma

Abstract: In our cohort of patients with pituitary tumors who underwent GKRS, 30% developed new hypopituitarism during the follow-up period.

Cited by 19 publications

References 32 publications

Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study

Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study

Machine-Learning Prediction of Postoperative Pituitary Hormonal Outcomes in Nonfunctioning Pituitary Adenomas: A Multicenter Study

Characteristic of Tumor Regrowth After Gamma Knife Radiosurgery and Outcomes of Repeat Gamma Knife Radiosurgery in Nonfunctioning Pituitary Adenomas

Contact Info

Product

Resources

About