Long-term Outcomes After Gamma Knife Stereotactic Radiosurgery for Nonfunctional Pituitary Adenomas

Park, Kyung Jae; Kano, Hideyuki; Parry, Phillip V.; Niranjan, Ajay; Flickinger, John C.; Lunsford, L. Dade; Kondziolka, Douglas

doi:10.1227/neu.0b013e318222afed

Cited by 113 publications

(81 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…37 Comparable data of the long-term outcomes of GKRS for nonfunctioning adenomas from Park et al noted a 90% tumor control rate in 125 patients, with a mean follow-up of 62 months. 45 Similarly, Gopalan et al demonstrated a tumor control rate of 83% with a median follow-up of 95 months. 20 Each of these studies noted that tumor volume was a predictor of new neurological decline, including delayed hypopituita- rism.…”

mentioning

confidence: 92%

“…Most large radiosurgical series demonstrate a tumor control rate approaching 90%. 45,52 In a more recent multicenter study of 512 patients, overall tumor control was achieved in 93.4% of patients at the lastfollow-up with actuarial tumor control rates of 98%, 95%, 91%, and 85% at 3, 5, 8, and 10 years after radiosurgery, respectively. 53 Despite the efficacy of stereotactic radiosurgery, there remains a lack of general consensus on its role in the spectrum of treatment.…”

mentioning

confidence: 98%

“…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.…”

mentioning

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...…”

mentioning

confidence: 99%

“…20 Each of these studies noted that tumor volume was a predictor of new neurological decline, including delayed hypopituita- rism. 37,45,56 One explanation for tumor growth after GKRS might reside in the fact that larger adenomas in proximity to radiation-sensitive structures may limit the delivery of an ideal radiosurgical dose.…”

mentioning

confidence: 99%

See 4 more Smart Citations

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

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

View full text Add to dashboard Cite

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...

show abstract

mentioning

confidence: 92%

mentioning

confidence: 98%