Hormonal and radiologic outcomes after gamma knife radiosurgery for nonfunctioning pituitary adenomas

ObjectiveThis study aimed to report the characteristic of tumor regrowth after gamma knife radiosurgery (GKRS) and outcomes of repeat GKRS in nonfunctioning pituitary adenomas (NFPAs).Design and MethodsThis retrospective study consisted of 369 NFPA patients treated with GKRS. The median age was 45.2 (range, 7.2–84.0) years. The median tumor volume was 3.5 (range, 0.1–44.3) cm3.ResultsTwenty-four patients (6.5%) were confirmed as regrowth after GKRS. The regrowth-free survivals were 100%, 98%, 97%, 86% and 77% at 1, 3, 5, 10 and 15 year, respectively. In multivariate analysis, parasellar invasion and margin dose (<12 Gy) were associated with tumor regrowth (hazard ratio [HR] = 3.125, 95% confidence interval [CI] = 1.318–7.410, p = 0.010 and HR = 3.359, 95% CI = 1.347–8.379, p = 0.009, respectively). The median time of regrowth was 86.1 (range, 23.2–236.0) months. Previous surgery was associated with tumor regrowth out of field (p = 0.033). Twelve patients underwent repeat GKRS, including regrowth in (n = 8) and out of field (n = 4). Tumor shrunk in seven patients (58.3%), remained stable in one (8.3%) and regrowth in four (33.3%) with a median repeat GKRS margin dose of 12 (range, 10.0–14.0) Gy. The actuarial tumor control rates were 100%, 90%, 90%, 68%, and 68% at 1, 3, 5, 10, and 15 years after repeat GKRS, respectively.ConclusionsParasellar invasion and tumor margin dose (<12 Gy) were independent risk factors for tumor regrowth after GKRS. Repeat GKRS might be effective on tumor control for selected patients. For regrowth in field due to relatively insufficient radiation dose, repeat GKRS might offer satisfactory tumor control. For regrowth out of field, preventing regrowth out of field was the key management. Sufficient target coverage and close follow-up might be helpful.

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Clinical and Radiologic Outcome of Gamma Knife Radiosurgery on Nonfunctioning Pituitary Adenomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1549309 ◽

2015 ◽

Vol 76 (05) ◽

pp. 351-357 ◽

Cited By ~ 15

Author(s):

Shyamal Bir ◽

Richard Murray ◽

Sudheer Ambekar ◽

Papireddy Bollam ◽

Anil Nanda

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Nonfunctioning Pituitary Adenomas

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Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0408 ◽

2002 ◽

Vol 97 ◽

pp. 408-414 ◽

Cited By ~ 99

Author(s):

Jason P. Sheehan ◽

Douglas Kondziolka ◽

John Flickinger ◽

L. Dade Lunsford

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Visual Fields ◽

Gamma Knife Radiosurgery ◽

Tumor Control ◽

Content Type ◽

Cavernous Sinus Invasion ◽

Nonfunctioning Pituitary Adenomas ◽

Fine Print

Object. Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. Methods. A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. Conclusions. Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

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Editorial: Gamma Knife radiosurgery and nonfunctioning pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2013.10.jns132248 ◽

2014 ◽

Vol 120 (3) ◽

pp. 645-646

Author(s):

Kalman Kovacs

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Nonfunctioning Pituitary Adenomas

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Long-term results of Gamma Knife Radiosurgery for Postsurgical residual or recurrent nonfunctioning Pituitary Adenomas

International Journal of Medical Sciences ◽

10.7150/ijms.47168 ◽

2020 ◽

Vol 17 (11) ◽

pp. 1532-1540

Author(s):

Yinhui Deng ◽

Yanli Li ◽

Xi Li ◽

Lisha Wu ◽

Tingting Quan ◽

...

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Long Term Results ◽

Nonfunctioning Pituitary Adenomas

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Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2013.11.jns131757 ◽

2014 ◽

Vol 120 (3) ◽

pp. 647-654 ◽

Cited By ~ 30

Author(s):

Cheng-Chia Lee ◽

Hideyuki Kano ◽

Huai-Che Yang ◽

Zhiyuan Xu ◽

Chun-Po Yen ◽

...

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Outcome Data ◽

Tumor Control ◽

Surgical Removal ◽

Tumor Margin ◽

Tumor Control Rate ◽

Nonfunctioning Pituitary Adenomas

Object Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management. Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In this report, the authors evaluated the efficacy and safety of initial GKRS for NFAs. Methods An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs. Results Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2–25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025). Conclusions In this study, GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma.

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