Pituitary Adenomas Treated by Microsurgery with or without Gamma Knife Surgery: Experience in 122 Cases

Inoué, Hiroshi; Kohga, Hideaki; Hirato, Masafumi; Sasaki, Takehiko; Ishihara, Junko; Shibazaki, Toshio; Ohye, C.; Andou, Yoshitaka

doi:10.1159/000056448

Cited by 61 publications

(31 citation statements)

References 4 publications

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“…This technique permits treatment of tumors invading the cavernous sinus, more rapid resolution of ACTH hypersecretion, and the convenience of delivering the full dose of radiation in only one sitting. Furthermore, the amount of radiation received by normal brain tissue is minimized, thus theoretically reducing the incidence of central nervous system side effects [4,5,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Devin

Allen

Cmelak

et al. 2004

Stereotact Funct Neurosurg

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We identified 35 patients who had undergone stereotactic radiosurgery (SRS) for their biochemically proven Cushing’s disease in order to assess the efficacy of SRS with regard to control of hypercortisolism, improvement of clinical features and prevention of tumor progression, and subsequent incidence of hypopituitarism. Seventeen (49%) patients achieved control of their cortisol levels following SRS; the mean time to normalization was 7.5 months (range: 1–33). Four (19%) patients experienced recurrent hypercortisolism at a mean time of 35.5 months following therapy (range: 17–64). Control of tumor progression was achieved in 91% patients. Fourteen (40%) patients demonstrated a new pituitary deficiency following SRS. Our results suggest that cortisol levels are normalized more efficiently and with a lower recurrence rate with SRS than with conventional fractionated external beam radiotherapy (EBT). We have confirmed the near 100% tumor control rate reported with SRS. The percentage of patients developing pituitary insufficiency following SRS is less than that of patients having undergone EBT; however, deficits occurred up to 10 years posttreatment. We advocate the use of SRS as the primary therapeutic modality in those patients who are poor surgical candidates, or as the adjunct treatment to microsurgery in eliminating residual tumor cells or disease that is not easily amenable to resection.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Devin

Allen

Cmelak

et al. 2004

Stereotact Funct Neurosurg

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“…Therefore, it is not the treatment of choice to young patients who intend to become pregnant. The more recent use of stereotactic radiosurgery requires longer follow-up in order to demonstrate its superiority [15][16][17]. For this reason radiotherapy has been indicated only in cases of surgical failure and resistance to DA, mainly in invasive tumors.…”

Section: Treatment Of Prolactinomasmentioning

confidence: 99%

Prolactinomas and Pregnancy

Bronstein

2005

Pituitary

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Prolactinomas are the most frequent pituitary tumors. Treatment of infertility in such tumors usually is very successful. On the other hand, reports of pituitary tumor growth during pregnancy have been described since bromocriptine started to be used. Since then, dopamine agonists (DA) have been increasingly used as the first-choice treatment of prolactinomas, with surgery being reserved for resistance or persistent intolerance to DA or for special situations. More recently other DA, such as quinagolide and cabergoline have shown better tolerance than bromocriptine with similar or greater efficacy. Cabergoline is now the first choice drug but its use in pregnancy is still under evaluation. We followed 71 term pregnancies in women bearing microprolactinomas. Of the 22 patients with previous surgery, none presented symptoms of tumor growth. Of the 41 pregnant patients treated with bromocriptine alone, only one (2.4%) presented with headaches, which regressed with drug reintroduction. Fifty one term pregnancies in patients with macroprolactinomas were followed by us. Of those, 21 were in patients with previous surgery and none of them presented clinical evidence of tumor growth. On the other hand, of the 30 patients treated only with pre-gestational bromocriptine, 11 (37%) manifested complaints related to tumor growth. A non-hormonal contraceptive should be the use along with a DA drug until tumor shrinkage within sellar boundaries has been evidenced. After pregnancy has been confirmed, the DA can be withdrawn and the patient must be closely followed. If tumor expansion is suspected, confirmation can be made through MRI and by visual field testing. Reintroduction of bromocriptine in such cases can lead to tumor reduction and clinical improvement. Surgery can also be employed as treatment for symptomatic tumor growth in pregnancy.

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“…The reported tumour control in SRS studies in patients with Cushing's disease was 94% at a corrected median follow-up of 45 months (table 2) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). This compares to the 5-year tumour control rate (progression free survival) in all pituitary adenomas of 91.5% (39)(40)(41)(42), which is worse than reported following fractionated RT even though the tumours treated are smaller.…”

Section: Radiosurgerymentioning

confidence: 78%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

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Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease. RESUMORadioterapia e Radiocirurgia para a Doença de Cushing. Pacientes com doença de Cushing residual ou recorrente recebem radioterapia externa em feixe (RT) com o objetivo de alcançar um controle tumoral prolongado e a normalização dos níveis hormonais elevados. O tratamento é realizado tanto com RT convencional, usando técnicas conformacionais, ou com RT estereotáxica, que é usada tanto como tratamento fracionado (RTF) ou como radiocirurgia em procedimento único (RCU). Descreveremos os aspectos técnicos do tratamento e mostraremos uma revisão sistemática da literatura sobre a eficácia e toxicidade da RT convencional, da RTF e da RCU. Não existem estudos comparando diretamente as diferentes técnicas de radiação, e os resultados reportados são inevitavelmente os de pacientes selecionados pelos investigadores com interesse no tratamento testado. De qualquer maneira, a revisão dos dados publicados sugere que há melhores taxas de controle hormonal e tumoral após RTF em comparação com RCU. O hipopituitarismo representa a complicação tardia mais comumente relatada da RT, vista após todos os tipos de tratamento. Embora a incidência de outros efeitos tardios seja baixa, o risco de a radiação comprometer estrutura...

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Pituitary Adenomas Treated by Microsurgery with or without Gamma Knife Surgery: Experience in 122 Cases

Cited by 61 publications

References 4 publications

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Prolactinomas and Pregnancy

Radiotherapy and radiosurgery for Cushing's disease

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