Stereotactic Radiosurgery for Residual and Recurrent Nonfunctioning Pituitary Adenomas: A Contemporary Case Series of GammaKnife and CyberKnife Radiosurgery

Abstract OBJECTIVE To evaluate tumor control rates and complications after stereotactic radiosurgery for patients with nonfunctioning pituitary adenomas. METHODS Between 1992 and 2000, 33 patients underwent radiosurgery for treatment of nonfunctioning pituitary adenomas. Thirty-two patients (97%) had undergone one or more previous tumor resections. Twenty-two patients (67%) had enlarging tumors before radiosurgery. The median tumor margin dose was 16 Gy (range, 12–20 Gy). The median follow-up period after radiosurgery was 43 months (range, 16–106 mo). RESULTS Tumor size decreased for 16 patients, remained unchanged for 16 patients, and increased for 1 patient. The actuarial tumor growth control rates at 2 and 5 years after radiosurgery were 97%. No patient demonstrated any decline in visual function. Five of 18 patients (28%) with anterior pituitary function before radiosurgery developed new deficits, at a median of 24 months after radiosurgery. The actuarial risks of developing new anterior pituitary deficits were 18 and 41% at 2 and 5 years, respectively. No patient developed diabetes insipidus. CONCLUSION Stereotactic radiosurgery safely provides a high tumor control rate for patients with recurrent or residual nonfunctioning pituitary adenomas. However, despite encouraging early results, more long-term information is needed to determine whether radiosurgery is associated with lower risks of new endocrine deficits and radiation-induced neoplasms, compared with fractionated radiotherapy.

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Stereotactic Radiosurgery XVI: A Treatment for Previously Irradiated Pituitary Adenomas

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2002-020356 ◽

2003 ◽

Vol 88 (11) ◽

pp. 5334-5340 ◽

Cited By ~ 41

Author(s):

F. M. Swords ◽

C. A. Allan ◽

P. N. Plowman ◽

A. Sibtain ◽

J. Evanson ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Pituitary Adenomas ◽

Conventional Therapy ◽

Complementary Therapy ◽

External Irradiation ◽

Conventional Radiotherapy ◽

Nonfunctioning Pituitary Adenomas ◽

Igf I ◽

Pretreated Group ◽

Heavily Pretreated

Abstract We report the use of stereotactic radiosurgery delivered through an adapted linear accelerator [stereotactic multiple arc radiation therapy (SMART)] for pituitary adenomas not cured by conventional therapy. All 21 patients had undergone conventional radiotherapy (45–50 Gy); 18 had also undergone prior surgery. This cohort comprised 13 patients with somatotrope adenomas, four with corticotrope adenomas, one with a lactotrope adenoma, and three with nonfunctioning pituitary adenomas (median follow-up: 33 months, range: 3–72 months). SMART has proven effective, safe, and rapidly acting. We observed an accelerated reduction in GH and IGF-I levels in acromegaly, with normalization of GH and IGF-I levels in 58%. Mean GH fell from 21.1 mU/liter to 7.9 mU/liter (7 ng/ml to 2.6 ng/ml, P < 0.01, median 25 months) faster than our predicted fall to 50% at 2 yr with conventional radiotherapy. Mean IGF-I fell from 624 ng/ml to 384 ng/ml (P < 0.001). Tumor growth was controlled in two of three nonfunctioning pituitary adenomas, and three of four corticotrope adenomas. There were no adverse effects from SMART. Notably there have been no visual sequelae or further loss of anterior pituitary function in this heavily pretreated group. Our data indicate that SMART is an effective complementary therapy for pituitary adenomas that have displayed a suboptimal response to conventional therapy including external irradiation.

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18F‑fallypride and 11C‑methionine positron emission tomography/computed tomography for the study of prolactinomas and nonfunctioning pituitary adenomas: A case series

World Journal of Nuclear Medicine ◽

10.4103/wjnm.wjnm_83_20 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Omar Alonso ◽

Andres Damian ◽

MariaM Pineyro ◽

Adriana Quagliata ◽

Mariana Risso ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Pituitary Adenomas ◽

Case Series ◽

Emission Tomography ◽

Nonfunctioning Pituitary Adenomas ◽

Positron Emission

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Factors Associated with Pituitary Insufficiency after Stereotactic Radiosurgery of Patients with Nonfunctioning Pituitary Adenomas

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.06.682 ◽

2008 ◽

Vol 72 (1) ◽

pp. S221-S222

Author(s):

J.L. Leenstra ◽

S. Tanaka ◽

R.W. Kline ◽

P.D. Brown ◽

B.E. Pollock

Keyword(s):

Stereotactic Radiosurgery ◽

Pituitary Adenomas ◽

Pituitary Insufficiency ◽

Factors Associated ◽

Nonfunctioning Pituitary Adenomas

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Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opz085 ◽

2019 ◽

Vol 18 (1) ◽

pp. 26-33

Author(s):

Andrew S Little ◽

Michael R Chicoine ◽

Daniel F Kelly ◽

Christina E Sarris ◽

Michael A Mooney ◽

...

Keyword(s):

Patient Outcomes ◽

Predictive Value ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Case Series ◽

Residual Tumor ◽

Pituitary Surgery ◽

Extent Of Resection ◽

Subtotal Resection ◽

Nonfunctioning Pituitary Adenomas

Abstract BACKGROUND The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. RESULTS GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P < .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.

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The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Neurosurgical FOCUS ◽

10.3171/2010.7.focus10159 ◽

2010 ◽

Vol 29 (4) ◽

pp. E11 ◽

Cited By ~ 19

Author(s):

Christopher J. Stapleton ◽

Charles Y. Liu ◽

Martin H. Weiss

Keyword(s):

Growth Hormone ◽

Stereotactic Radiosurgery ◽

Pituitary Adenomas ◽

Case Series ◽

Hormonal Control ◽

Adjunctive Treatment ◽

Common Source ◽

Effective Treatment Option ◽

Multimodal Management

Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

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