patients with nonfunctioning pituitary adenoma were treated with hypofractionated SRT. Forty-three patients were male, and 57 were female. The patient's ages ranged from 16 to 82 years (median, 59 years). Five patients were medically inoperable, and 1 refused surgery; the remaining 94 were recurrent cases or those receiving postoperative adjuvant SRT. No patients had a history of previous cranial radiotherapy. Tumor volume ranged from 0.7 to 64.3 mL (median, 5.1 mL). The marginal doses were 17.0 to 21.0 Gy for the 3-fraction schedule and 22.0 to 25.0 Gy for the 5-fraction schedule. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for living patients was 33 months (range, 18 -118.5 months). The 3-year overall survival and local control rates were 98% and 98%, respectively. In-field and out-field tumor regrowth were observed in 3 and 2 patients, respectively. Transient cyst enlargement occurred in 3 cases. A post-SRT grade 2 visual disorder occurred in 1 patient. Symptomatic post-SRT hypopituitarism was observed in 3 of 74 patients who had not received hormone replacement therapy after surgery.CyberKnife SRT involving 21 Gy in 3 fractions or 25 Gy in 5 fractions is safe and effective for surgical treatment of nonfunctioning pituitary adenoma. Hypofractionated SRT appears useful for protecting the visual nerve and neuroendocrine function, especially for tumors located near the optic pathways and large tumors.Keywords: CyberKnife, hypofractionated stereotactic radiotherapy, nonfunctioning, optic pathway, pituitary adenoma. P ituitary adenoma (PA) is a benign tumor that occurs mainly in adults between 20 and 50 years of age and constitutes about 10 -20% of all intracranial tumors.1,2 PA is divided into functioning and nonfunctioning varieties, and the purpose and method of treatment differ for the two entities. Treatment for functioning PA aims to prevent the excessive secretion of anterior pituitary lobe hormone. On the other hand, treatment of nonfunctioning PA is typically intended to control tumor volume and prevent or reverse visual disorders and endocrinopathies. Tumors that cause visual symptoms are treated primarily with transsphenoidal surgery or craniotomy; and if patients are asymptomatic, a wait-and-see approach may be taken. Nonfunctioning PA is not necessarily treated by immediate radiotherapy (RT) after resection, unlike functioning PA. However, several studies have reported recurrences in about 20 -50% of cases treated with surgery alone. 3 -5 Radiotherapy is considered if residual or recurrent tumors invade the cavernous sinus or in cases in which repeated surgeries have resulted in fibrosis and Corresponding Author: Hiromitsu Iwata, MD, PhD, Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan (h-iwa-ncu@nifty.com). inoperability. In the past, conventional RT was used to treat such cases. 6 -8 Considering the proximity of organs at ri...

Craniopharyngiomas are slow-growing tumors found in the suprasellar region, with especially high incidence in Japanese children. Due to the location, proximity and adhesiveness of the tumor to adjacent critical structures, these tumors remain a significant clinical challenge. The purpose of this study was to evaluate the clinical outcome of single and hypofractionated stereotactic radiotherapy (SRT) with CyberKnife for craniopharyngioma. Forty-three patients (21 men and 22 women; median age 44 years; range 3-85 years) were treated at two institutions. Three cases were treated in a single fraction to a marginal dose of 13-16 Gy. The other 40 cases were treated in 2-5 fractions to a marginal dose of 13-25 Gy. Tumor volumes ranged from 0.09 to 20.8 cm(3) (median 2.0 cm(3)). Toxicities were evaluated with the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period was 40 months (range 12-92 months). The 3-year overall survival and local control rates were 100 and 85%, respectively. In-field cyst enlargement was observed in 9 patients. These tumors had significantly larger volumes (mean 6.9 cm(3); 95% confidence interval, CI, 2.8-10.9 cm(3)) than the 34 controlled tumors (2.9 cm(3); CI 1.5-4.3 cm(3)) (P = 0.02). Out-field tumor regrowth was observed in 4 patients. No radiation-induced symptomatic visual disorder or brain necrosis was observed. Hypopituitarism was observed in only 1 patient. Single and hypofractionated SRT using CyberKnife produced high tumor control rates with minimal complications. Hypofractionated SRT may be useful for protecting the visual nerve and neuroendocrine function, especially for tumors located near the optic pathways and for large tumors.

BackgroundTo assess inter-observer variability in delineating target volume and organs at risk in benign tumor adjacent to optic tract as a quality assurance exercise.MethodsWe quantitatively analyzed 21 plans made by 11 clinicians in seven CyberKnife centers. The clinicians were provided with a raw data set (pituitary adenoma and meningioma) including clinical information, and were asked to delineate the lesions and create a treatment plan. Their contouring and plans (10 adenoma and 11 meningioma plans), were then compared. In addition, we estimated the influence of differences in contouring by superimposing the respective contours onto a default plan.ResultsThe median planning target volume (PTV) and the ratio of the largest to the smallest contoured volume were 9.22 cm3 (range, 7.17 - 14.3 cm3) and 1.99 for pituitary adenoma, and 6.86 cm3 (range 6.05 - 14.6 cm3) and 2.41 for meningioma. PTV volume was 10.1 ± 1.74 cm3 for group 1 with a margin of 1 -2 mm around the CTV (n = 3) and 9.28 ± 1.8 cm3(p = 0.51) for group 2 with no margin (n = 7) in pituitary adenoma. In meningioma, group 1 showed larger PTV volume (10.1 ± 3.26 cm3) than group 2 (6.91 ± 0.7 cm3, p = 0.03). All submitted plan keep the irradiated dose to optic tract within the range of 50 Gy (equivalent total doses in 2 Gy fractionation). However, contours superimposed onto the dose distribution of the default plan indicated that an excessive dose 23.64 Gy (up to 268% of the default plan) in pituitary adenoma and 24.84 Gy (131% of the default plan) in meningioma to the optic nerve in the contours from different contouring.ConclusionQuality assurance revealed inter-observer variability in contour delineation and their influences on planning for pituitary adenoma and meningioma near optic tract.

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Abstract:The comparative studies on anthelmintic potency of Carica papaya seeds was investigated in naturally infected Red Sokoto goats. Forty Red Sokoto goats (average 12 ± 0.25 kg body weight) infected naturally with helminthes were used to compare anthelminthic potency of Carica papaya seeds in aqueous and crude extract forms and Thiabendazole treatment against intestinal worms. The animals were randomly assigned into four treatment groups (A, B, C and D) consisting of 10 Red Sokoto goats per group. The animals in group A were not treated (negative control) while B undergone thiabendazole anthelmintic treatment (positive control). Groups C and D were given the powdery and aqueous forms of C. papaya seed extract via feed at 300 mg/ kg body weight/day and at 1:10 ml (w/v) of water respectively for 3 days. Before anthelmintic treatments and 1 st and 2 nd weeks after administering the anthelminthics, faecal and blood samples were collected for parasitological and haematological analysis. Data collected were subjected to one-way ANOVA. Treatments of both aqueous and powdery forms of C. papaya seed extract resulted a significant increase (p < 0.05) in packed cell volume (PCV), red blood cell (RBC) and haemoglobin concentration and lymphocyte counts. Conversely, there was significant (p > 0.05) decrease in the eosinophil counts. The reduction in the faecal egg counts of helminth when C. papaya seed extracts applied was significantly (p < 0.05) comparable to those obtained for Thiabendazole treatment. However, the efficacy of aqueous form of C. papaya seed extract was more significant (p < 0.05) than the crude (powdery) extract administered via the feed. The study therefore concludes that C. papaya seed extracts have comparable anthelmintic potency to Thiabendazole and that aqueous forms were more efficient than powdery forms when administered in Red Sokoto goats as an alternative to anthelmintic to synthetic dewormers in rural areas in controlling helminthosis.