scholarly journals The Clinical Outcome of Hypofractionated Stereotactic Radiotherapy With CyberKnife Robotic Radiosurgery for Perioptic Pituitary Adenoma

2016 ◽  
Vol 15 (6) ◽  
pp. NP10-NP15 ◽  
Author(s):  
Putipun Puataweepong ◽  
Mantana Dhanachai ◽  
Ake Hansasuta ◽  
Somjai Dangprasert ◽  
Thiti Swangsilpa ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Fractionated Stereotactic Radiotherapy ◽  
Tumor Control ◽  
Optic Pathway ◽  
Hypofractionated Stereotactic Radiotherapy ◽  
Single Fraction ◽  
Robotic Radiosurgery ◽  
Cyberknife Robotic Radiosurgery

Stereotactic radiation technique including single fraction radiosurgery and conventional fractionated stereotactic radiotherapy is widely reported as an effective treatment of pituitary adenomas. Because of the restricted radiation tolerance dose of the optic pathway, single fraction radiosurgery has been accepted for small tumor located far away from the optic apparatus, while fractionated stereotactic radiotherapy may be suitable for larger tumor located close to the optic pathway. More recently, hypofractionated stereotactic radiotherapy has become an alternative treatment option that provides high rate of tumor control and visual preservation for the perioptic lesions within 2 to 3 mm of the optic pathway. The objective of the study was to analyze the clinical outcomes of perioptic pituitary adenomas treated with hypofractionated stereotactic radiotherapy. From 2009 to 2012, 40 patients with perioptic pituitary adenoma were treated with CyberKnife robotic radiosurgery. The median tumor volume was 3.35 cm3 (range, 0.82-25.86 cm3). The median prescribed dose was 25 Gy (range, 20-28 Gy) in 5 fractions (range, 3-5). After the median follow-up time of 38.5 months (range, 14-71 months), 1 (2.5%) patient with prolactinoma had tumor enlargement, 31 (77.5%) were stable, and the remaining 8 (20%) tumors were smaller in size. No patient’s vision deteriorated after hypofractionated stereotactic radiotherapy. Hormone normalization was observed in 7 (54%) of 13 patients. No newly developed hypopituitarism was detected in our study. These data confirmed that hypofractionated stereotactic radiotherapy achieved high rates of tumor control and visual preservation. Because of the shorter duration of treatment, it may be preferable to use hypofractionated stereotactic radiotherapy over fractionated stereotactic radiotherapy for selected pituitary adenomas immediately adjacent to the optic apparatus.

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.

Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 90-92 ◽  
Author(s):  
Mark E. Linskey
Keyword(s):  
Gamma Knife ◽  
Stereotactic Radiotherapy ◽  
Three Dimensional ◽  
Late Recurrence ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Content Type ◽  
Single Fraction ◽  
Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

Fractionated Stereotactic Radiotherapy for Pituitary Adenomas

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 406-417 ◽  
Author(s):  
Sean M. Barber ◽  
Bin S. Teh ◽  
David S. Baskin
Keyword(s):  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Progression Free Survival ◽  
Hormonal Control ◽  
Fractionated Stereotactic Radiotherapy ◽  
Small Series ◽  
Early Results ◽  
Nonfunctional Pituitary Adenomas

Abstract BACKGROUND Early results of postoperative fractionated stereotactic radiotherapy (FSRT) for functional and nonfunctional pituitary adenomas appear promising, but the majority of available evidence draws from small series with insufficient follow-up data to draw meaningful conclusions. OBJECTIVE To evaluate the long-term outcomes of a large series of patients undergoing FSRT for both functional and nonfunctional pituitary adenomas with the Novalis system (Brain LAB, Heimstetten, Germany). METHODS Chart data for 75 consecutive patients undergoing FSRT for a pituitary tumor (21 functional and 54 nonfunctional adenomas) at our institution between January 2004 and June 2013 were reviewed. RESULTS Radiographic progression-free survival was 100% over a mean of 47.8 months of radiographic follow-up (range, 12.0-131.2 months). Hormonal normalization was seen in 69.2% of patients with functional adenomas after FSRT, whereas 30.8% experienced partial hormonal control. Mild, grade I acute adverse effects were observed during radiotherapy treatment in 36 patients (48%), and objective, persistent worsening of vision occurred in a single patient (1.5%) after FSRT. New hormonal deficits were seen in 28.0% of patients after FSRT. Radiographic responses were inversely related to tumor volume. CONCLUSION FSRT delivers radiographic and functional outcomes similar to those seen with stereotactic radiosurgery and conventional radiotherapy with less resultant toxicity. FSRT is most beneficial for smaller tumors (those <3 cm in diameter).

Dose to neuroanatomical structures surrounding pituitary adenomas and the effect of stereotactic radiosurgery on neuroendocrine function: an international multicenter study

2021 ◽  
pp. 1-9
Author(s):  
I. Jonathan Pomeraniec ◽  
Zhiyuan Xu ◽  
Cheng-Chia Lee ◽  
Huai-Che Yang ◽  
Tomas Chytka ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Stereotactic Radiosurgery ◽  
Multicenter Study ◽  
Pituitary Adenomas ◽  
Pituitary Stalk ◽  
Tumor Control ◽  
Single Fraction ◽  
Neuroendocrine Function ◽  
Normal Pituitary Gland ◽  
The Impact

OBJECTIVE Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism after SRS. In this multicenter study by the International Radiosurgery Research Foundation (IRRF), the authors aimed to evaluate radiation tolerance of structures surrounding pituitary adenomas and identify predictors of delayed hypopituitarism after SRS for these tumors. METHODS This is a retrospective review of patients with pituitary adenomas who underwent single-fraction SRS from 1997 to 2019 at 16 institutions within the IRRF. Dosimetric point measurements of 14 predefined neuroanatomical structures along the hypothalamus, pituitary stalk, and normal pituitary gland were made. Statistical analyses were performed to determine the impact of doses to critical structures on clinical, radiographic, and endocrine outcomes. RESULTS The study cohort comprised 521 pituitary adenomas treated with SRS. Tumor control was achieved in 93.9% of patients over a median follow-up period of 60.1 months, and 22.5% of patients developed new loss of pituitary function with a median treatment volume of 3.2 cm3. Median maximal radiosurgical doses to the hypothalamus, pituitary stalk, and normal pituitary gland were 1.4, 7.2, and 11.3 Gy, respectively. Nonfunctioning adenoma status, younger age, higher margin dose, and higher doses to the pituitary stalk and normal pituitary gland were independent predictors of new or worsening hypopituitarism. Neither the dose to the hypothalamus nor the ratio between doses to the pituitary stalk and gland were significant predictors. The threshold of the median dose to the pituitary stalk for new endocrinopathy was 10.7 Gy in a single fraction (OR 1.77, 95% CI 1.17–2.68, p = 0.006). CONCLUSIONS SRS for the treatment of pituitary adenomas affords a high tumor control rate with an acceptable risk of new or worsening endocrinopathy. This evaluation of point dosimetry to adjacent neuroanatomical structures revealed that doses to the pituitary stalk, with a threshold of 10.7 Gy, and doses to the normal gland significantly increased the risk of post-SRS hypopituitarism. In patients with preserved pre-SRS neuroendocrine function, limiting the dose to the pituitary stalk and gland while still delivering an optimal dose to the tumor appears prudent.

scholarly journals P14.78 Hypofractionated stereotactic radiotherapy as a salvage therapy for recurrent high-grade gliomas: Single-center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii86-iii86
Author(s):  
T Reynaud ◽  
A Bertaut ◽  
W Farah ◽  
D Thibouw ◽  
G Crehange ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Stereotactic Radiotherapy ◽  
Tumor Control ◽  
High Grade ◽  
Single Center ◽  
Hypofractionated Stereotactic Radiotherapy ◽  
Number Of Patients ◽  
High Grade Gliomas ◽  
Grade Iii

Abstract BACKGROUND The standard of care for patients with recurrent glioblastoma or grade III glioma has not yet been clearly defined and many approaches are available for salvage strategies. These include surgery, re-irradiation or systemic agents. For the treatment of High-Grade (HGG) recurrence by radiation therapy, Hypofractionated Stereotactic Radiotherapy (HFSRT) is an interesting approach because it is minimally invasive, ambulatory, short-lasting and well tolerated. The aim of this study was to evaluate the efficacy of and safety to HFSRT as alvage treatment for patients suffering from HGG relapse in our cancer center and to compare these results with the literature. MATERIAL AND METHODS Between March 2012 and March 2017, 32 consecutive patients (12 women, 20 men) treated in a single-center were retrospectively included included in this study.Grade III gliomas were diagnosed in 14 patients and grade IV in 18 patients. Thirty-four lesions were treated with HFSRT on LINAC. HFSRT delivered a dose of 30 Gy in six fractions of 5Gy (27 Gy in three fractions for one patient) with two or three fractions per week. The treatment plans were normalized to 100% at the isocenter, and prescribed to the 80 % isodose line. Clinical outcomes and prognostic factors were analyzed. RESULTS HFSRT characteristics: The median tumor volume was of 6.1 (0.1–42.2) cm3 and the median PTV was 15 (0.6–67.5) cm3. The median maximum dose, median minimum dose and median mean dose were 38.7 (32.7–42.0) Gy, 29.1 (14.0–32.4) Gy and 35.1 (31.5–37.5) Gy, respectively. Median follow-up was 20.9 months. Median overall survival (OS) following HFSRT was 15.6 months (Median OS for patients patients with GBM and grade III glioma were 8.2 and 19.5 months, respectively; p=0.0496). Progression-free survival (PFS) was 3.7 months (Median PFS for patients with GBM and grade III glioma were 3.6 and 4.5months, respectively; p=0.2424). In multivariate analysis, tumor grade III (p=0.0027), an ECOG status <2 at the time of reirradiation (p=0.0023) and a mean dose >35 Gy (p=0.0055) significantly improved OS. A maximum reirradiation dose above 38 Gy (p=0.0179) was significantly associated with longer PFS. Treatment was well tolerated, no acute toxicity > grade 2 was observed. During the follow-up, ten patients (31.25%) had suspected radionecrosis. In six patients, this suspicion corresponded to tumor progression. For the other patients, radionecrosis was suggested on multi-modal MRI. CONCLUSION HFSRT appears to be a feasible and effective salvage treatment option for recurrent high-grade gliomas, with OS of 15.6 months. Prognostic factors associated with longer OS were a good general state of health and grade III glioma. Dosimetric data suggested that the dose gradient had an impact on tumor control and indicate that a study with dose-escalation is warranted. These results need to be confirmed in a prospective study with a greater number of patients.

PO-0774: Fractionated stereotactic radiotherapy for the treatment of pituitary adenomas

2014 ◽  
Vol 111 ◽  
pp. S49
Author(s):  
M. Zurita-Herrera ◽  
M.I. Tovar-Martin ◽  
R. Del Moral-Ávila ◽  
R. Guerrero-Tejada ◽  
M. Martínez-Carrillo ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Fractionated Stereotactic Radiotherapy

Reduced-Dose Fractionated Stereotactic Radiotherapy for Acoustic Neuromas

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 489-496 ◽  
Author(s):  
Colin E. Champ ◽  
Xinglei Shen ◽  
Wenyin Shi ◽  
Sonal U. Mayekar ◽  
Katherine Chapman ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Hearing Preservation ◽  
Fractionated Stereotactic Radiotherapy ◽  
Symptom Improvement ◽  
Tumor Control ◽  
Noninvasive Treatment ◽  
Reduced Dose ◽  
Acoustic Neuromas ◽  
Cranial Nerve Dysfunction

Abstract BACKGROUND: Fractionated stereotactic radiotherapy (FSRT) is a noninvasive treatment for acoustic neuromas (ANs). Initial reports from our institution demonstrated that the reduction of treatment dose to 46.8 Gy resulted in improved preservation of functional hearing status. OBJECTIVE: We now report the tumor control (TC), symptomatic outcome, and hearing preservation (HP) rate in patients treated with reduced-dose FSRT. METHODS: We analyzed all patients with AN treated from 2002 to 2011. All patients received 46.8 Gy in 1.8-Gy fractions. Follow-up audiogram and magnetic resonance imaging were performed in ⩽1-year intervals. TC and HP were calculated by the Kaplan-Meier method. Analysis of HP, defined as Gardner-Robertson value ⩽2, was determined by audiometric data. Non-hearing-related symptoms were defined by Common Terminology Criteria for Adverse Events version 4. RESULTS: In total, 154 patients were analyzed. At a median follow-up of 35 months (range, 4-108), TC was achieved in 96% of patients (n = 148/154) and at 3 and 5 years was 99% and 93%. Eighty-seven patients had serviceable hearing at the time of FSRT and evaluable audiometric follow-up. Overall HP was 67% and at 3 and 5 years was 66% and 54%. Pure tone average decreased by a median of 13 dB in all patients. Nineteen percent (n = 31) of patients experienced symptom improvement, and 8% (n = 13) had worsening of symptoms. Cranial nerve dysfunction occurred in 3.8% of patients (n = 6). CONCLUSION: Reduced-dose FSRT to 46.8 Gy for AN achieves excellent functional HP rates and limited toxicity without compromising long-term TC. Based on these promising outcomes, further attempts at dose deescalation may be warranted.

scholarly journals PO-0713: Fractionated stereotactic radiotherapy for pituitary adenomas

2018 ◽  
Vol 127 ◽  
pp. S365
Author(s):  
I. Tovar Martin ◽  
M. Zurita Herrera ◽  
P. Vargas Arrabal ◽  
P. Galván Banqueri ◽  
R. Guerrero Tejada ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Pituitary Adenomas ◽  
Fractionated Stereotactic Radiotherapy
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