Safety and efficacy of fractionated stereotactic radiotherapy and stereotactic radiosurgery for treatment of pituitary adenomas: A systematic review and meta-analysis

2017 ◽  
Vol 372 ◽  
pp. 110-116 ◽  
Author(s):  
Xuezhen Li ◽  
Yanbin Li ◽  
Yang Cao ◽  
Peiliang Li ◽  
Bo Liang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Fractionated Stereotactic Radiotherapy ◽  
Safety And Efficacy

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

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.

Fractionated Stereotactic Radiotherapy as an Adjuvant Therapy for Pituitary Adenomas

2010 ◽  
Vol 6 (2) ◽  
pp. 42 ◽  
Author(s):  
Camilla Schalin-Jäntti ◽  
Keyword(s):  
Adjuvant Therapy ◽  
Stereotactic Radiosurgery ◽  
Adjuvant Treatment ◽  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Optic Chiasm ◽  
Fractionated Stereotactic Radiotherapy ◽  
Stereotactic Techniques ◽  
Conventional Radiotherapy ◽  
Medical Interventions

Pituitary adenomas characterised by excessive growth or hormonal overproduction despite surgical and medical interventions are a treatment challenge. This article discusses fractionated stereotactic radiotherapy (FSRT) as an adjuvant treatment for pituitary adenomas. Previously, management largely depended on conventional radiotherapy (RT). RT is effective but induces irradiation of surrounding healthy tissues, which has raised safety concerns. With the introduction of modern high-precision stereotactic techniques, irradiation of surrounding tissues can be avoided. The dose can be delivered in one (stereotactic radiosurgery) or several fractions (FSRT). While the use of radiosurgery is restricted to smaller tumours located away from the optic chiasm and nerves, there are no such restrictions for FSRT. FSRT provides an efficient and safe option for pituitary adenomas refractory to conventional treatments. The results seem to be at least as good as those achieved with RS but no direct comparison of these two techniques is yet available.

Endocrinological outcome after pituitary transposition (hypophysopexy) and adjuvant radiotherapy for tumors involving the cavernous sinus

2011 ◽  
Vol 115 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Philipp Taussky ◽  
Ricky Kalra ◽  
Jeroen Coppens ◽  
Jahan Mohebali ◽  
Randy Jensen ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Residual Tumor ◽  
Fractionated Stereotactic Radiotherapy ◽  
Normal Pituitary Gland ◽  
Radiotherapy Treatment

Object Stereotactic radiosurgery and fractionated stereotactic radiotherapy are commonly used in the treatment of residual or recurrent benign tumors of the skull base and cavernous sinus. A major risk associated with radiosurgical or radiotherapy treatment of residual or recurrent tumors adjacent to normal functional pituitary gland is radiation of the pituitary, which frequently leads to the development of hypopituitarism. The authors have used a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual tumor within the cavernous sinus. Here, the authors analyze the long-term endocrinological outcomes in patients with residual and recurrent tumors who undergo hypophysopexy and adjuvant radiosurgical or conformal fractionated radiotherapy treatment. Methods Pituitary transposition involves placement of a fat graft between the normal pituitary gland and residual tumor in the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and the graft is interposed between the pituitary gland and the residual tumor. The residual tumor may then be treated with stereotactic radiosurgery or conformal fractionated radiation therapy. The authors evaluated endocrinological outcome, safety of the procedure, and postoperative complications in patients who underwent this procedure during a 7-year period. Results Hypophysopexy has been used in 34 patients with nonfunctioning pituitary adenomas (19), functional pituitary adenomas (8), chordomas (2), meningiomas (2), chondrosarcoma (1), hemangiopericytoma (1), or hemangioma (1) involving the sella and cavernous sinus. Follow-up (radiographic and endocrinological) has been performed yearly in all patients. Two patients experienced postoperative endocrine deficits before radiosurgery (1 transient), but none of the patients developed new hypopituitarism during the median 4-year follow-up (range 1–8 years) after radiosurgery or fractionated stereotactic radiotherapy. Conclusions The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery or radiotherapy and effectively reduces the incidence of radiation injury to the normal pituitary gland when compared with historical controls.

scholarly journals Stereotactic radiosurgery for non-functioning pituitary adenomas: meta-analysis and International Stereotactic Radiosurgery Society practice opinion

2019 ◽  
Vol 22 (3) ◽  
pp. 318-332 ◽  
Author(s):  
Rupesh Kotecha ◽  
Arjun Sahgal ◽  
Muni Rubens ◽  
Antonio De Salles ◽  
Laura Fariselli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Random Effects ◽  
Local Control ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Review Reports ◽  
Meta Analyses ◽  
Non Functioning Pituitary Adenomas

Abstract Background This systematic review reports on outcomes and toxicities following stereotactic radiosurgery (SRS) for non-functioning pituitary adenomas (NFAs) and presents consensus opinions regarding appropriate patient management. Methods Using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review was performed from articles of ≥10 patients with NFAs published prior to May 2018 from the Medline database using the key words “radiosurgery” and “pituitary” and/or “adenoma.” Weighted random effects models were used to calculate pooled outcome estimates. Results Of the 678 abstracts reviewed, 35 full-text articles were included describing the outcomes of 2671 patients treated between 1971 and 2017 with either single fraction SRS or hypofractionated stereotactic radiotherapy (HSRT). All studies were retrospective (level IV evidence). SRS was used in 27 studies (median dose: 15 Gy, range: 5–35 Gy) and HSRT in 8 studies (median total dose: 21 Gy, range: 12–25 Gy, delivered in 3–5 fractions). The 5-year random effects local control estimate after SRS was 94% (95% CI: 93.0–96.0%) and 97.0% (95% CI: 93.0–98.0%) after HSRT. The 10-year local control random effects estimate after SRS was 83.0% (95% CI: 77.0–88.0%). Post-SRS hypopituitarism was the most common treatment-related toxicity observed, with a random effects estimate of 21.0% (95% CI: 15.0–27.0%), whereas visual dysfunction or other cranial nerve injuries were uncommon (range: 0–7%). Conclusions SRS is an effective and safe treatment for patients with NFAs. Encouraging short-term data support HSRT for select patients, and mature outcomes are needed before definitive recommendations can be made. Clinical practice opinions were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).

scholarly journals Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis

2019 ◽  
Vol 46 (6) ◽  
pp. E2 ◽  
Author(s):  
Nida Fatima ◽  
Antonio Meola ◽  
Erqi L. Pollom ◽  
Scott G. Soltys ◽  
Steven D. Chang
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Tumor Control ◽  
Case Control Studies ◽  
Intracranial Meningiomas

OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

Fractionated Stereotactic Radiotherapy: A Short Review

2002 ◽  
Vol 1 (3) ◽  
pp. 153-172 ◽  
Author(s):  
Wolfgang A. Tomé ◽  
Minesh P. Mehta ◽  
Sanford L. Meeks ◽  
John M. Buatti
Keyword(s):  
Stereotactic Radiosurgery ◽  
Clinical Experience ◽  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Malignant Gliomas ◽  
Short Review ◽  
Fractionated Stereotactic Radiotherapy ◽  
Low Grade

Currently, optimally precise delivery of intracranial radiotherapy is possible with stereotactic radiosurgery and fractionated stereotactic radiotherapy. We present in this article a review of the underlying basic physical and radiobiological principles of fractionated stereotactic radiotherapy and review the clinical experience for ateriovenus malformations, pituitary adenomas, mengiomas, vestibular schwanomas, low grade astrocytomas, malignant gliomas, and brain metatases.

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