Long-term results of Gamma Knife Radiosurgery for Postsurgical residual or recurrent nonfunctioning Pituitary Adenomas

Deng, Yao; Li, Yanli; Li, Xi; Wu, Lijuan; Quan, Tingting; Peng, Chao; Fu, Junyi; Yang, Xin; Yu, Jinxiu

doi:10.7150/ijms.47168

Cited by 14 publications

(5 citation statements)

References 29 publications

(65 reference statements)

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“…Study details, treatment overview and outcomes are reported in Table 1 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Across all 18 papers, the median number of patients treated in single institutional case series was 57 (range, 30–272 patients).…”

Section: Resultsmentioning

confidence: 99%

“…Random effects meta-analysis for five-year PFS are shown in Figure 2 b, with estimates of 95% (95% CI: 91–99%; I 2 = 0%, p = 1.00). Only six studies reported the 10-year PFS ranging 74–92% [ 11 , 12 , 17 , 18 , 19 ]. Notably, referring to tumor volume decrease after GK, the majority of studies reported a rate tumor shrinkage of at least 50% (range, 25–83%) over time.…”

Section: Resultsmentioning

confidence: 99%

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Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

Albano

Losa

Barzaghi

et al. 2021

Cancers

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To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89–97%) and 95% (95% CI 91–99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35–54%) for GH-secreting adenomas, 64% (95% CI 0.52–0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19–48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67–81%) and 70% (95% CI: 64–76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

Albano

Losa

Barzaghi

et al. 2021

Cancers

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“…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: 86%

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.

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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.

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“…4 SRS affords high tumor control rates, estimated to range between 89% and 91%. [5][6][7] Its popularity has emerged from the benefits of a minimally invasive approach, a modest risk profile, and the convenience of an outpatient procedure. 8 In SRS dose planning, achievement of tumor control with minimal treatment-related morbidity depends on the radiation dose delivered to the pituitary adenoma, the distance from the SRS target to critical hypothalamic-pituitary axis (HPA) neuroanatomic structures and the resultant SRS doses delivered along the HPA.…”

mentioning

confidence: 99%

“…4 SRS affords high tumor control rates, estimated to range between 89% and 91%. 5-7 Its popularity has emerged from the benefits of a minimally invasive approach, a modest risk profile, and the convenience of an outpatient procedure. 8…”

mentioning

confidence: 99%

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

Ironside

Chen

et al. 2023

Neurosurgery

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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.

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Long-term results of Gamma Knife Radiosurgery for Postsurgical residual or recurrent nonfunctioning Pituitary Adenomas

Cited by 14 publications

References 29 publications

Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

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

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

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