Radiosurgery-induced brain tumor

Kaido, Toshimi; Hoshida, Tohru; Uranishi, Ryunosuke; Akita, Nobuhisa; Kotani, Akihira; Nishi, Noriyuki; Sakaki, Toshisuke

doi:10.3171/jns.2001.95.4.0710

Cited by 147 publications

(48 citation statements)

References 22 publications

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“…20,44,47,56 A 50% rate of hypopituitarism at 20 years after conventional radiotherapy has been reported for those patients with normal pretreatment endocrine function. 27,37 Early experience with SRS in which pneumoencephalography was used for targeting produced similar results with respect to pituitary function.…”

Section: Complications Of Srsmentioning

confidence: 99%

Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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The most common cause of Cushing syndrome is Cushing disease, in which hypercortisolism is produced by a functional adrenocorticotropic hormone–producing adenoma of the anterior pituitary gland. The common therapies available include microsurgical resection, conventional fractionated radiotherapy, and stereotactic radiosurgery (SRS). In this article the authors review the indications, results, and complications associated with SRS in the treatment of Cushing disease. In as many as 90% of patients SRS results in disease remission, which is defined as a normal 24-hour urinary free cortisol level and a normal or subnormal morning serum cortisol level. Although in most patients who are subsequently cured a marked decrease in the serum cortisol level is demonstrated within 3 months after treatment, a biochemical cure may be delayed up to 3 years in some cases. Complications following SRS for pituitary adenomas are uncommon, particularly in patients with microadenomas, which are most commonly seen in Cushing disease. The most common complication is hypopituitarism, which occurs in up to 50% of patients with a mean latency period of 5 years. Radiation-induced optic neuropathy has been reported in less than 2% of cases and induction of a secondary neoplasm in less than 1% of cases. For patients with Cushing disease, the rate of endocrinological cure following SRS appears to be similar to that attained using microsurgical resection. In contrast to surgery, SRS has the benefit of being noninvasive and associated with a very low incidence of diabetes insipidus, although hypopituitarism may be more common with SRS. With continued follow-up patient reviews and additional experience with SRS, it may become possible to make more definitive statements regarding SRS as the initial treatment for patients with Cushing disease.

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Section: Complications Of Srsmentioning

confidence: 99%

Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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“…These criteria are met by 26 cases in the literature of malignant degeneration of a tumor or development of a new tumor [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]; 3 reports also describe the development of cavernous malformations after SRS [34,35]. For 1 of these cases, the cavernous malformation was in the exact location of the lesion previously treated with SRS that was initially presumed to be a metastasis [34]; 1 of the other cases involved a patient with multiple cavernous malformations, making radiation less likely to be a causative factor [31].…”

Section: Discussionmentioning

confidence: 99%

The Risk of Malignancy Anywhere in the Body after Linear Accelerator (LINAC) Stereotactic Radiosurgery

Rahman¹,

Neal²,

Baruch³

et al. 2014

Stereotact Funct Neurosurg

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Background: Despite the conformity of stereotactic radiosurgery (SRS) treatment, there are concerns about the risk of malignancy. Objective: We compared the number of cancer cases observed after treatment in a group of SRS patients to the number of cancer cases that would be expected in an age- and gender-matched group. Methods: We collected data from the University of Florida SRS database for patients treated for meningiomas, intracranial schwannomas, arteriovenous malformations (AVMs), trigeminal neuralgia, pituitary adenomas, cavernous angiomas, and metastases. We used the Florida Cancer Data System (FCDS) to determine the actual cancer rates for SRS-treated patients, and we compared these to the cancer rates in similar groups of non-SRS-treated patients based on rates available from the SEER (surveillance epidemiology and end results) database. Results: A total of 2,369 patients were analyzed. Of these, 862 were patients with metastases who were analyzed only to ensure the sensitivity of using the FCDS to determine malignancy rates. The results for patients with more than 5 years of follow-up are reported. Without the metastases patients, a total of 627 patients had more than 5 years of follow-up data. Follow-up in patient-years was 1,711 for the meningioma patients, 1,851 for the schwannoma patients, 1,407 for the AVM patients and 338 for patients with a diagnosis of ‘other'. The observed cancer rate in the meningioma patients was 3.96% compared to the expected rate of 10% (binomial 95% confidence interval, CI = 1.85-7.94). The observed cancer rate in the schwannoma patients was 4.93% compared to the expected rate of 12.5% (95% CI = 2.61-8.89). The observed cancer rate in the AVM patients was 3.64% compared to the expected rate of 4.43% (95% CI = 1.49-8.10). The observed cancer rate in patients treated for other diagnoses (e.g. pituitary adenoma or trigeminal neuralgia) was 0% compared to the expected rate of 6.36% (95% CI = 0-11.7). Conclusions: In a large population of SRS-treated patients, there was no increased risk of malignancy compared to the general population.

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“…Brain metastases are the most common adult brain tumor, affecting 100,000-170,000 people annually in the United States 29 . Metastatic brain tumors have high incidence and follow a rapidly progressive course, requiring complex management which includes a combination of surgery, radiation and radiosurgery 30 .…”

Section: Stereotactic Radiosurgery For Brain Metastasesmentioning

confidence: 99%