Radiosurgery for Nonfunctioning Pituitary Adenomas

Neurosurgery ◽  
2005 ◽  
Vol 56 (4) ◽  
pp. 699-705 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Katsunobu Yoshioka
Keyword(s):  
Tumor Growth ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Growth Control ◽  
Cyst Formation ◽  
Morbidity Rate ◽  
Nonfunctioning Pituitary Adenomas ◽  
Long Term Follow Up

Abstract OBJECTIVE: We evaluated the effectiveness of gamma knife radiosurgery in the treatment of nonfunctioning pituitary adenomas. METHODS: Between January 1994 and December 1999, we treated 34 patients with nonfunctioning pituitary adenomas. Thirty-one of these patients were followed for more than 30 months. Their mean age was 52.9 years. All patients underwent resection before radiosurgery. In four patients, treatment was performed with staged radiosurgery. The treatment volume was 0.7 to 36.2 cm3 (median, 2.5 cm3). The treatment dose ranged from 8 to 20 Gy (median, 14.0 Gy) to the tumor margin. In 15 patients (48.4%), the tumor either compressed or was attached to the optic apparatus. The maximum dose to the optic apparatus was from 2 to 11 Gy (median, 8 Gy). RESULTS: Patients were followed for 30 to 108 months (median, 59.8 mo). The tumor size decreased in 18 patients (58.1%), remained unchanged in 9 patients (29.0%), and increased in four patients (12.9%). The 5-year actual tumor growth control rate was 93%. Among patients with tumor growth, two cases were secondary to cyst formation. Two patients (6.5%) required adrenal and thyroid hormonal replacement during the follow-up period after radiosurgery because of radiation-induced endocrinopathy. None of the patients sustained new cranial nerve deficits, which included optic neuropathy. CONCLUSION: In this series, radiosurgery had a high tumor growth control rate during the long-term follow-up period. Furthermore, we observed a low morbidity rate, with endocrinopathies and optic neuropathies. This low rate included even patients in whom the tumor compressed or was attached to the optic apparatus. We emphasize the necessity of long-term follow-up to evaluate late complications.

Postsurgical Salvage Radiosurgery for Nonfunctioning Pituitary Adenomas Touching/Compressing the Optic Chiasm: Median 13-Year Postirradiation Imaging Follow-up Results

Neurosurgery ◽  
2018 ◽  
Vol 85 (4) ◽  
pp. 476-485 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Hitoshi Aiyama ◽  
Takao Koiso ◽  
Shinya Watanabe ◽  
Takuya Kawabe ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Pituitary Adenomas ◽  
Growth Control ◽  
Optic Chiasm ◽  
Long Term Results ◽  
Nonfunctioning Pituitary Adenomas ◽  
Tumor Periphery ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND There is little information on long-term outcomes after salvage treatment by either surgery or stereotactic radiosurgery (SRS) for patients with recurrent/residual nonfunctioning pituitary adenomas (NFPAs). OBJECTIVE To reappraise the efficacy and safety of SRS for patients with NFPAs touching/compressing the optic apparatus (OA). METHODS We studied 27 patients (14 females, 13 males; mean age: 61 [range, 19-85] yr) who underwent SRS between 1998 and 2008 for NFPAs with such condition. The median tumor volume was 4.9 (range, 1.8-50.8) cc. To avoid excess irradiation to the OA, the lower part of the tumor was covered with a 50% or a 60% isodose gradient, ie 49% to 98% (mean, 84%; median, 88%) of the entire tumor received the selected doses. Median doses at the tumor periphery/OA were 7.6/11.0 (interquartile range [IQR], 5.8-9.1/10.1-11.8) Gy. RESULTS Seven patients (26%) were confirmed to be deceased due to unrelated diseases at a median post-SRS period of 149 (IQR, 83-158) mo. Follow-up magnetic resonance imaging (MRI) showed tumor growth in 2 patients (7%) at the 11th and 134th post-SRS month; the former underwent surgery and the other SRS. Excluding these 2 patients, the latest follow-up MRI examinations, performed 13 to 238 (median: 168, IQR: 120-180) mo after SRS, showed no size changes in 5 (19%) and shrinkage in 20 (74%) patients. Cumulative incidences of tumor growth control were 96.3% and 91.8% at the 120th and 180th post-SRS month. None of our patients developed subjective symptoms suggesting SRS-induced optic neuropathy or endocrinological impairment. CONCLUSION In patients with NFPAs touching/compressing the OA, SRS achieves good long-term results.

Proliferation Index of Nonfunctioning Pituitary Adenomas: Correlations with Clinical Characteristics and Long-term Follow-up Results

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1313-1319 ◽  
Author(s):  
Marco Losa ◽  
Alberto Franzin ◽  
Francesca Mangili ◽  
Maria Rosa Terreni ◽  
Raffaella Barzaghi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Clinical Characteristics ◽  
Proliferation Index ◽  
Nonfunctioning Pituitary Adenomas ◽  
Long Term Follow Up

Gamma Knife Surgery of Meningiomas Involving the Cavernous Sinus

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 661-669 ◽  
Author(s):  
Bente Sandvei Skeie ◽  
P. Ø. Enger ◽  
G. O. Skeie ◽  
F. Thorsen ◽  
P-H. Pedersen
Keyword(s):  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Complication Rate ◽  
Growth Control ◽  
Gamma Knife Surgery ◽  
Long Term Outcome ◽  
Long Term Follow Up

Abstract OBJECTIVE Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. METHODS 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0–243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients. RESULTS Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6–20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives. CONCLUSION GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.

Proliferation Index of Nonfunctioning Pituitary Adenomas: Correlations with Clinical Characteristics and Long-term Follow-up Results

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1313-1319 ◽  
Author(s):  
Marco Losa ◽  
Alberto Franzin ◽  
Francesca Mangili ◽  
Maria Rosa Terreni ◽  
Raffaella Barzaghi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Clinical Characteristics ◽  
Ki 67 ◽  
Nonfunctioning Pituitary Adenomas ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
The Mean

ABSTRACT OBJECTIVE The recurrence of nonfunctioning pituitary adenomas (NFPAs) after surgical removal is common. The aim of our study was to investigate and correlate the growth fraction of NFPAs with clinical characteristics and long-term follow-up results. METHODS Tumor specimens were obtained from 101 consecutive patients with NFPAs (48 female patients and 53 male patients; mean age, 52.0 ± 1.5 yr). Specimens were immediately fixed in 10% buffered formalin and then embedded in paraffin. The Ki-67 antigen was assessed by immunocytochemical analysis using the monoclonal antibody MIB-1. The Ki-67 antigen labeling index (LI) was determined by counting a total of at least 1000 neoplastic nuclei. RESULTS The mean Ki-67 LI for the 101 patients was 2.4 ± 0.3% (range, 0–23.0%). Only age at surgery was inversely correlated with the Ki-67 LI; sex, maximal tumor diameter, and invasiveness into the cavernous sinuses did not significantly affect the Ki-67 LI. The mean follow-up period was 39.7 ± 2.1 months. During follow-up monitoring, 23 patients experienced tumor recurrence, after a mean period of 28.6 ± 4.8 months. Invasiveness of the tumor on preoperative magnetic resonance imaging scans was the strongest predictor of late tumor recurrence, followed by previous pituitary surgery, younger age, and lack of postoperative radiotherapy. The Ki-67 LI had no independent prognostic value. CONCLUSION Our study suggests that the clinical characteristics of patients with NFPAs, except for age at surgery, are not correlated with the Ki-67 LI. Moreover, the Ki-67 LI does not seem to provide independent information to identify patients at high risk for tumor recurrence.

Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Antonio Santacroce ◽  
Maja Walier ◽  
Jean Régis ◽  
Roman Liščák ◽  
Enrico Motti ◽  
...  
Keyword(s):  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Morbidity Rate ◽  
Tumor Control ◽  
Imaging Data ◽  
Long Term Follow Up ◽  
Male Patients

Abstract BACKGROUND Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published. METHODS From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.). RESULTS Median tumor volume was 4.8 cm3, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up > 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P > .001), for female vs male patients (P > .001), for sporadic vs multiple meningiomas (P > .001), and for skull base vs convexity tumors (P > .001). Permanent morbidity rate was 6.6% at the last follow-up. CONCLUSION Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

scholarly journals Stereotactic radiosurgery for the treatment of glomus tumors

2018 ◽  
Vol 20 (2) ◽  
pp. 136-142
Author(s):  
Vladimir Zaccariotti ◽  
João Arruda ◽  
Jean Paiva ◽  
Wenzel Abreu ◽  
Criseide Dourado ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Cranial Nerves ◽  
Growth Control ◽  
Slight Reduction ◽  
Lower Cranial Nerve ◽  
Shaped Beam ◽  
Glomus Jugulare ◽  
Long Term Follow Up

Introduction: Despite of being a slow growing hypervascular benign tumor, Glomus Jugulare is a challenge for the neurosurgeon, due to its complex localization and relation to the cranial nerves. Microsurgery alone or associated with radiation therapy have been used for decades, and is frequently associated with severe neurological sequelae. In the last decade, radiosurgery has been employed for tumor growth control, but long term follow up is still missing. Objective: The objective is to analyze the late results of radiosurgery alone in the treatment of glomus jugulare tumors. Material and Methods: From a series of 596 patients submitted to radiosurgery at our institution, seven patients with eight complex glomus jugulare tumors were selected. All patients were submitted to radiosurgery, 4 men and 3 women, age 20 to 78. The median volume of the lesions was 12.56 cc (range from 3.06 to 19.6 cc). The primary symptoms were pain and tinnitus, one patient had facial palsy before the initial treatment. Two patients were submitted to surgery before radiosurgery, and both developed lower cranial dysfunction, one of them underwent to conventional radiotherapy before radiosurgery. The patients received a single dose of 18 Gy to 20 Gy, using a LINAC with a conformal shaped beam collimator. Results: All patients had important pain relief (no more medication necessary) and a follow up of 30 to 96 months showed slight reduction in all of eight lesions. No patient suffered a new lower cranial nerve deficit after conformal shaped beam radiosurgery. Conclusion: Despite of the small number of cases, long term follow-up showed that radiosurgery is safe and effective to provide tumor growth control and to reduce pain associated with glomus jugulare tumors.

scholarly journals Low-dose Gamma Knife surgery for nonfunctioning pituitary adenomas

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 84-88 ◽  
Author(s):  
Amr M. N. El-Shehaby ◽  
Wael A. Reda ◽  
Sameh R. Tawadros ◽  
Khaled M. Abdel Karim
Keyword(s):  
Tumor Growth ◽  
Pituitary Adenomas ◽  
Growth Control ◽  
Visual Field Defects ◽  
Nonfunctioning Pituitary Adenomas ◽  
Pituitary Dysfunction ◽  
Hormone Profile ◽  
Visual Improvement ◽  
The Mean

Object The primary concern when performing Gamma Knife surgery for pituitary adenoma is preservation of vision and pituitary function while achieving tumor growth control. Higher prescribed radiation doses are typically correlated with higher incidences of postradiosurgical hormone deficiencies. The goal of the present study was to retrospectively analyze the feasibility of using a lower prescribed radiation dose in the treatment of nonfunctioning pituitary adenomas and the effect of this dose on vision, pituitary function, and tumor growth control. Methods The study was conducted in 38 patients with nonfunctioning pituitary adenomas, who were treated between January 2002 and July 2008. Twenty-one patients were available for follow-up (13 men and 8 women). The mean follow-up period was 44 months (range 24–90 months). Nineteen patients had previously undergone surgery. Pituitary dysfunction developed after surgery in 3 patients. One patient had an abnormal pituitary hormone profile before radiosurgery due to an attack of pituitary apoplexy. Visual field defects were present in 12 patients. The prescribed radiation dose was 12 Gy in all patients. The tumor volume ranged from 0.5 to 11.8 cm3 (mean 4.8 cm3). The maximum dose to the visual pathway was kept below 10 Gy. The mean maximum dose delivered to the visual pathway was 7.9 Gy. Results The patients were followed up for a period of 24 to 90 months (mean 44 months). The size of the tumor decreased in 11 patients (52%) and remained stable in 9 patients (43%). In 1 patient there was tumor growth outside the previous radiation field (on the contralateral side). Among the 12 patients with visual field defects, 9 (75%) experienced an improvement and the remaining patients' vision remained stable. In only 4 patients was the visual improvement associated with tumor shrinkage. The hormone profile remained normal in all patients except for the 4 patients who had pituitary dysfunction before radiosurgery. Conclusions The 12-Gy prescribed dose used in this study seems to be sufficient for producing tumor control while sparing the patient from radiation-induced pituitary dysfunction. In addition, visual improvement was reported in a number of cases. A larger series and longer follow-up are required to confirm these results.

Sign in / Sign up

Export Citation Format

Share Document