Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

Kobayashi, Tatsuya; Mori, Yoshimasa; Uchiyama, Yukio; Kida, Yoshihisa; Fujitani, Shigeru

doi:10.3171/jns.2005.102.s_supplement.0119

Cited by 44 publications

(15 citation statements)

References 18 publications

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“…Despite the proximity of the optic apparatus to the pituitary gland, only 10 case series 5,7,13,17,18,25,32,44,58,62 in our analysis reported postradiosurgical visual complications, with Kobayashi et al 25 demonstrating the highest incidence at 11%. The low rate of visual complications following SRS likely stems from each group's attempt to limit the dose received by the optic apparatus to 8-10 Gy.…”

Section: Adverse Effectsmentioning

confidence: 54%

“…Thus, unlike the optic apparatus, which is especially sensitive to radiation dosing, the structures traversing the cavernous sinus appear more resistant to injury. 50,56 Kobayashi et al 25 reported postradiosurgical visual complications in 11% of the 67 patients with acromegaly in their study, yet new-onset optic neuropathies were only noted in a total of 10 case series in our review of the literature. To minimize damage to the optic apparatus, many groups attempt to limit the dose it receives to 8-10 Gy.…”

Section: Discussionmentioning

confidence: 96%

“…Not all series, however, documented such impressive rates of endocrinological remission at the time of last follow-up. As examples, Kobayashi et al 25 and Castinetti et al 5 observed hormonal normalization in only 17% of patients when they were not receiving medical therapy. Such disparities likely reflect important differences in patient populations, adenoma characteristics, preradiosurgical hormonal control, and treatment regimens.…”

Section: Endocrinological Remission and Controlmentioning

confidence: 99%

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The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stapleton

Liu

Weiss

2010

FOC

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Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

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Section: Adverse Effectsmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 96%

Section: Endocrinological Remission and Controlmentioning

confidence: 99%

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The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stapleton

Liu

Weiss

2010

FOC

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“…1,2,7,10,13,14,18,24,26,[29][30][31]33) Descriptions of the endocrine and radiographic outcomes of GKRS for GH-secreting adenomas are summarized in Table 2. In these studies, the mean follow-up periods ranged from 35 to 120 months.…”

Section: Gh-secreting Adenomas I Gamma Knifementioning

confidence: 99%

Stereotactic Radiosurgery/Radiotherapy for Pituitary Adenomas: A Review of Recent Literature

Kajiwara

Saitô²,

Yoshikawa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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The recent clinical results are reviewed of stereotactic radiosurgery/radiotherapy for the treatment of pituitary adenomas. The outcomes of pituitary adenomas treated by stereotactic radiosurgery/radiotherapy with gamma knife, CyberKnife, or linear accelerator (LINAC) radiosurgery were evaluated from articles published after 2004. Each study was evaluated for the number of patients, radiosurgical parameter (marginal dose), length of follow up, tumor growth control, rate of hormonal normalization in secretary adenomas, and adverse events. After gamma knife radiosurgery, the tumor reduction rates varied from 42.3% to 89% in non-secreting adenomas. However, the tumor control rates in non-secreting adenomas were more than 90% in most studies. In growth hormone-secreting adenomas, the rates of insulin-like growth factor-1 normalization ranged from 36.9% to 82%. In adrenocorticotropin-secreting adenomas, the rates for 24-hour urine free cortisol normalization ranged from 27.9% to 54%. In prolactin-secreting adenomas, the prolactin normalization ranged from 17.4% to 50%. New hormonal deficits ranged from 0% to 34%. New visual deficits were relatively low. The number of patients treated with CyberKnife and LINAC radiosurgery/radiotherapy was small and follow-up periods were relatively short compared to those with gamma knife treatment, but the clinical outcomes after these therapies were similar to those after gamma knife therapy. Image-guided stereotactic radiosurgery/radiotherapy with the gamma knife, CyberKnife, or LINAC system is effective and safe against pituitary adenomas. Careful long-term follow up of the patients is necessary because of longterm anti-tumor effects and delayed adverse events.

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“…5 One of the challenges for surgery and radiation is the close proximity of the pituitary adenoma to critical structures, such as the optic and abducens nerves and internal carotid arteries, 13 with reported visual side effects and cranial nerve palsies in up to 11% of patients. 14,15 Tumor-specific radiosensitizers could improve the therapeutic window of radiation therapy, and decrease adverse effects while improving efficacy.…”

Section: Introductionmentioning

confidence: 99%

Nelfinavir Induces Radiation Sensitization in Pituitary Adenoma Cells

Zeng

See

Aziz

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

Cited by 44 publications

References 18 publications

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stereotactic Radiosurgery/Radiotherapy for Pituitary Adenomas: A Review of Recent Literature

Nelfinavir Induces Radiation Sensitization in Pituitary Adenoma Cells

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