Stereotactic Radiosurgery for Pituitary Adenoma

Abstract OBJECTIVE To analyze the factors associated with anterior pituitary deficits after pituitary adenoma stereotactic radiosurgery (SRS). METHODS The tumor, pituitary stalk, and pituitary gland were segmented on the dose plans of 82 patients (secreting tumors, n = 53; nonsecreting tumors, n = 29) for dose-volume analysis. No patient had undergone prior radiation therapy and all patients had at least 12 months of endocrinological follow-up (median, 63 months; mean, 69 months; range, 13–134). RESULTS Thirty-four patients (41%) developed new anterior pituitary deficits at a median of 32 months (range, 2–118) after SRS. The risk of developing new anterior pituitary deficits was 16% and 45% at 2 and 5 years, respectively. Multivariate analysis of the entire group showed that poor visualization of the pituitary gland (hazard ratio [HR] = 2.63, 95% confidence interval [CI] = 1.10–6.25, P = .03) was associated with a higher rate of new anterior pituitary deficits. Dosimetric analysis of 60 patients whose pituitary gland could be clearly identified showed that increasing mean pituitary gland radiation dose correlated with new anterior pituitary deficits (HR = 1.11, 95% CI = 1.02–1.20, P = .02). New anterior pituitary deficits stratified by mean pituitary gland radiation dose: ≤7.5 Gy, 0% (0/7); 7.6 to 13.2 Gy, 29% (7/24); 13.3 to 19.1 Gy, 39% (9/23); >19.1 Gy, 83% (5/6). CONCLUSION New endocrine deficits after pituitary adenoma radiosurgery were correlated with increasing radiation dose to the pituitary gland. Methods that limit the radiation dose to the pituitary gland during SRS may increase the probability of preserving pituitary function.

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Stereotactic Radiosurgery Outcomes for Atypical Pituitary Adenoma

10.1055/s-0039-1679790 ◽

2019 ◽

Author(s):

Avital Perry ◽

Christopher Graffeo ◽

Michael Link ◽

Bruce Pollock

Keyword(s):

Pituitary Adenoma ◽

Stereotactic Radiosurgery ◽

Atypical Pituitary Adenoma

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Acute hyperthermia following stereotactic radiosurgery for pituitary adenoma.

British Journal of Radiology ◽

10.1259/bjr.72.864.10703483 ◽

1999 ◽

Vol 72 (864) ◽

pp. 1218-1221 ◽

Cited By ~ 6

Author(s):

J A Kalapurakal ◽

C L Silverman ◽

N Akhtar ◽

B Downes ◽

D W Andrews ◽

...

Keyword(s):

Pituitary Adenoma ◽

Stereotactic Radiosurgery

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Hypopituitarism After Stereotactic Radiosurgery for Pituitary Adenomas

Neurosurgery ◽

10.1227/neu.0b013e3182846e44 ◽

2012 ◽

Vol 72 (4) ◽

pp. 630-637 ◽

Cited By ~ 66

Author(s):

Zhiyuan Xu ◽

Mary Lee Vance ◽

David Schlesinger ◽

Jason P. Sheehan

Keyword(s):

Pituitary Adenoma ◽

Radiation Dose ◽

Stereotactic Radiosurgery ◽

Tumor Control ◽

Increased Risk ◽

Free Cortisol ◽

Suprasellar Extension ◽

New Onset ◽

Stimulating Hormone

Abstract BACKGROUND: Studies of new-onset Gamma Knife stereotactic radiosurgery (SRS)-induced hypopituitarism in large cohort of pituitary adenoma patients with long-term follow-up are lacking. OBJECTIVE: We investigated the outcomes of SRS for pituitary adenoma patients with regard to newly developed hypopituitarism. METHODS: This was a retrospective review of patients treated with SRS at the University of Virginia between 1994 and 2006. A total of 262 patients with a pituitary adenoma treated with SRS were reviewed. Thorough endocrine assessment was performed immediately before SRS and in regular follow-ups. Assessment consisted of 24-hour urine free cortisol (patients with Cushing disease), serum adrenocorticotropic hormone, cortisol, follicle-stimulating hormone, luteinizing hormone, insulin-like growth factor-1, growth hormone, testosterone (men), prolactin, thyroid-stimulating hormone, and free T4. RESULTS: Endocrine remission occurred in 144 of 199 patients with a functioning adenoma. Tumor control rate was 89%. Eighty patients experienced at least 1 axis of new-onset SRS-induced hypopituitarism. The new hypopituitarism rate was 30% based on endocrine follow-up ranging from 6 to 150 months; the actuarial rate of new pituitary hormone deficiency was 31.5% at 5 years after SRS. On univariate and multivariate analyses, variables regarding the increased risk of hypopituitarism included suprasellar extension and higher radiation dose to the tumor margin; there were no correlations among tumor volume, prior transsphenoidal adenomectomy, prior radiation therapy, and age at SRS. CONCLUSION: SRS provides an effective and safe treatment option for patients with a pituitary adenoma. Higher margin radiation dose to the adenoma and suprasellar extension were 2 independent predictors of SRS-induced hypopituitarism.

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Internal carotid artery aneurysms diagnosed after stereotactic radiosurgery for a growth hormone-secreting pituitary adenoma: a case report and literature review

Acta Neurochirurgica ◽

10.1007/s00701-019-03840-5 ◽

2019 ◽

Vol 161 (6) ◽

pp. 1191-1195 ◽

Cited By ~ 1

Author(s):

Hirotaka Inoue ◽

Takayuki Kawano ◽

Yuki Ohmori ◽

Toshihiro Amadatsu ◽

Haruaki Yamamoto ◽

...

Keyword(s):

Growth Hormone ◽

Case Report ◽

Pituitary Adenoma ◽

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Stereotactic Radiosurgery ◽

Internal Carotid

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Comparing Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy in Treating patients with Growth Hormone-Secreting Adenomas: A Systematic Review and Meta-analysis

Endocrine Practice ◽

10.4158/ep-2020-0110 ◽

2020 ◽

Author(s):

Qiulin Zheng ◽

Yinqiong Huang ◽

Wei Lin ◽

Liangchun Cai ◽

Junping Wen ◽

...

Keyword(s):

Systematic Review ◽

Pituitary Adenoma ◽

Stereotactic Radiosurgery ◽

Stereotactic Radiotherapy ◽

Remission Rate ◽

Meta Analysis ◽

Fractionated Stereotactic Radiotherapy ◽

Tumor Control ◽

Cochrane Central Register ◽

Biochemical Remission

Context: Radiotherapy for patients with acromegaly was considered when patients have residual disease or tumor recurrence after surgery, or when surgery can’t be carried out. There are two main modes of radiotherapy, including stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT). Objective: We conducted a systematic review and meta-analysis to present the effectiveness and safety of SRS and FSRT for GH secreting pituitary adenoma in clinical practice. Methods: We searched the published literature using following databases: Pub Med, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and EMBASE up to March 22, 2020, for studies in which SRS or FSRT were used in patients with GH secreting pituitary. Results: A total of 33 studies were eligible, involving 2016 participants. No significant differences were observed in tumor shrinkage rate, local tumor control rate and adverse effect rate between SRS and FSRT. Compared to FSRT, SRS showed significant increase in biochemical remission rate (43% vs. 28%; p=0.023) and significant lower follow-up GH level (SMD: −1.20 vs. −0.37, p=0.006). Conclusions: SRS and FSRT showed comparable effectiveness and safety in the management of GH secreting pituitary adenoma patients. SRS might be associated with better biochemical remission.

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