Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery

Abstract

OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.METHODSThis was a retrospective, institutional review board–approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing’s disease and those with nonfunctioning adenoma (NFA).RESULTSThe entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing’s disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = −3.41, p = 0.003) and delayed memory (t = −3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.CONCLUSIONSOverall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.

Assessment of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Radiosurgery Treatment Planning for Pituitary Adenomas

“…Primary advantage of radiosurgery is management of patients with a condensed treatment schedule by use of one or a few fractions while achieving steep dose gradients around the target resulting in optimal normal tissue sparing. Nevertheless, excessive toxicity is an important concern for management of pituitary adenomas with radiosurgery a well as surgical resection and achieving an improved toxicity profile is a pertinent goal of irradiation as well to avoid adverse radiation effects [25,26]. In this context, several strategies have been implemented for avoiding excessive treatment toxicity such as deferral of irradiation, proton therapy, and combined modality management including surgery followed by SRS [27][28][29][30][31][32].…”

Lack of delayed neurocognitive side effects of Gamma Knife radiosurgery in acromegaly: the Later-Ac study

“…However, this study was very heterogeneous in terms of secretion profiles (for instance, 10 vs 4 patients with Cushing's disease were included in the unexposed and exposed groups, respectively, and this could then overestimate the rate of cognitive deficits in unexposed patients). Moreover, the mean follow-up after GK in the study was only 53.3 ± 35 months (15). Our study thus represents the first to suggest the lack of cognitive longterm side effects of GK in patients with acromegaly.…”

“…Indeed, longterm side effects of radiotherapy have been described more than 10 years after the procedure. Recently, Tooze and coworkers reported for the first time the lack of short-to mid-term neurocognitive differences in 51 patients treated for pituitary adenomas with GK, after a mean follow-up of 53 ± 35 months (15). However, the follow-up was rather short, and the group of patients was also heterogeneous in terms of secretion.…”

Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors

“…( 182 ). Very recent studies show reassuring data on the risk of developing neurocognitive deficits ( 185 ) or brain neoplasms ( 186 ), even though follow-up was limited to 5 and 8 years for psychometric and oncologic evaluations, respectively.…”