Radiosurgery for Pituitary Metastases

Iwai, Yoshiyasu; Yamanaka, Kazuhiro; Honda, Yuji; Matsusaka, Yasuhiro

doi:10.2176/nmc.44.112

Cited by 24 publications

(23 citation statements)

References 24 publications

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“…16,20 Furthermore, at the time of diagnosis, more than half of the patients have systemic metastasis. 9,11,14,18,20 Median survival reported in previous series ranged from 6 to 11 months; 11,13,16,18,20 survival rarely surpassed 3 years. 22 However, in the series of Morita et al, 3 of 36 patients survived at 5 years following diagnosis.…”

Section: Prognosismentioning

confidence: 88%

“…Iwai and colleagues reported that 6 of 7 patients achieved regional control and improvement of symptoms after stereotactic radiotherapy with a marginal dosage of 10-14 Gy (mean 11.9 Gy) using the Gamma Knife. 13 Kano et al reported their experience of treating 18 patients who harbored PMs using the Gamma Knife.…”

Section: Treatmentmentioning

confidence: 99%

“…16,20,24 Many authors have reported their own experiences or their institutional series on PMs. 3,11,13,14,20,26,31 There are also reviews involving large numbers of reported cas- results Between 1995 and 2010, 201 patients with PMs were treated by the participating physicians. The diagnosis of PM was histologically verified in 69 patients (34.3%).…”

mentioning

confidence: 99%

“…Magnetic resonance imaging has facilitated the early detection of sellar lesions, and the diagnosis of PMs has been reported to largely depend on these imaging studies. 13,14 Furthermore, recent reports have depicted cases of patients who survived long after the diagnosis. 13,31 We should, therefore, consider the lack of a clear clinical picture of this disease in the era of MRI and advanced cancer treatment, which are essential for proper management of this disease.…”

mentioning

confidence: 99%

“…13,14 Furthermore, recent reports have depicted cases of patients who survived long after the diagnosis. 13,31 We should, therefore, consider the lack of a clear clinical picture of this disease in the era of MRI and advanced cancer treatment, which are essential for proper management of this disease. Therefore, we conducted a questionnaire study to elicit the diagnostic practice, clinical and radiological features, treatment modalities, and prognosis of PMs treated during a recent 15-year period in Japan.…”

mentioning

confidence: 99%

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Pituitary metastases: current practice in Japan

Habu

Tokimura

Hirano

et al. 2015

JNS

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A lthough malignant tumors metastasizing into the pituitary fossa are not infrequent events in autopsy series, 6,10,17,18 pituitary metastasis (PM) is rarely diagnosed ante mortem. 3,14,18 According to the Brain Tumor Registry of Japan, only 0.4% of intracranial metastatic tumors are located in the pituitary gland. 5 These tumors account for only 1% of surgically treated pituitary tumors. 8,16,31 Recently, as the number of patients diagnosed with cancer has increased and their survival time has been extended, PMs have been diagnosed more frequently than before. 16,20,24 Many authors have reported their own experiences or their institutional series on PMs. 3,11,13,14,20,26,31 There are also reviews involving large numbers of reported cas- results Between 1995 and 2010, 201 patients with PMs were treated by the participating physicians. The diagnosis of PM was histologically verified in 69 patients (34.3%). In the other 132 patients (65.7%), the PM was diagnosed by their physicians based on neuroimaging findings and clinical courses. The most frequent primary tumor was lung (36.8%), followed by breast (22.9%) and kidney (7.0%) cancer. The average interval between diagnosis of primary cancer and detection of PM was 2.8 ± 3.9 (SD) years. Major symptoms at diagnosis were visual disturbance in 30.3%, diabetes insipidus in 27.4%, fatigue in 25.4%, headache in 20.4%, and double vision in 17.4%. Major neuroimaging features were mass lesion in the pituitary stalk (63.3%), constriction of tumor at the diaphragmatic hiatus (44.7%), hypothalamic mass lesion (17.4%), and hyperintensity in the optic tract (11.4%). Surgical treatment was performed in 26.9% of patients, and 74.6% had radiation therapy; 80.0% of patients who underwent radiotherapy had stereotactic radiotherapy. The median survival time was 12.9 months in total. Contributing factors for good prognosis calculated by Cox proportional hazard analysis were younger age, late metastasis to the pituitary gland, smaller PM size, and radiation therapy. The Kaplan-Meier survival was significantly better in patients with breast cancer and renal cell cancer than in those with lung cancer. coNclusioNs At the time of this writing, approximately 60% (120/201) of PMs had been treated by stereotactic radiation therapy in Japan. The median survival time was much longer than that reported in past series. To confirm the changes of clinical features and medical practice, a prospective and population-based survey is mandatory.

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Section: Prognosismentioning

confidence: 88%

Section: Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Pituitary metastases: current practice in Japan

Habu

Tokimura

Hirano

et al. 2015

JNS

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Hypofractionated stereotactic radiosurgery for pituitary metastases

et al. 2017

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Pituitary metastases (PMs) are uncommon, representing only 1% of pituitary lesions. The diagnosis of PMs can be challenging and an optimal management remains to be determined. Here, we present a pilot clinical study on the efficacy and safety of hypofractionated stereotactic radiosurgery (SRS) with an optimized dosimetric plan in treating PMs. Between June 2013 and December 2014, seven consecutive patients (4 men and 3 women; median age 62 years) had been diagnosed with PMs based on their characteristic clinical and radiological features and subsequently treated using hypofractionated SRS. Primary cancers originated from the lung (n = 5) or the breast (n = 2). All patients presented with diabetes insipidus (DI). Anterior pituitary and visual dysfunction were combined in 4 and 3 patients, respectively. On magnetic resonance imaging (MRI), PMs involved the pituitary stalk and/or the posterior lobe in all patients. SRS of a cumulative marginal dose 31 Gy with dose-volume constraints for the optic apparatus was delivered in 5 daily fractions. As results, tumor was locally controlled in all patients with substantial responses on MRI (including complete remission in 4 patients). The median survival time was 14 months (range, 6-24 months) after SRS. DI and visual dysfunction improved in all patients, although anterior pituitary dysfunction did not recover. No patients experienced any deterioration in visual, pituitary, or other cranial nerve functions. These results suggest a promising role of hypofractionated SRS in treating PMs in terms of both tumor control and functional outcomes.

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Current status and treatment modalities in metastases to the pituitary: a systematic review

Fomekong

Delabar

et al. 2020

J Neurooncol

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Radiosurgery for Pituitary Metastases

Cited by 24 publications

References 24 publications

Pituitary metastases: current practice in Japan

Pituitary metastases: current practice in Japan

Hypofractionated stereotactic radiosurgery for pituitary metastases

Current status and treatment modalities in metastases to the pituitary: a systematic review

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