Radiocirurgia nos adenomas hipofisários

Castro, Douglas Guedes de; Salvajoli, João Víctor; Canteras, Miguel Montes; Cecílio, Soraya A. Jorge

doi:10.1590/s0004-27302006000600004

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…In patients with acromegaly, regardless of the definition of a gold-standard assessment for the evaluation of disease control, the control criteria in published studies vary depending on the practicality of the tests available. Only in patients with prolactinoma, the test is homogeneous [14]. …”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

Castro¹,

Cecílio²,

Canteras³

2010

Radiat Oncol

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ObjectTo assess the effects of radiosurgery (RS) on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas.MethodsRetrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels) and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS.ResultsThe median follow-up was 42 months (6-109 months). The median dose was 12,5 Gy (9 - 15 Gy) and 20 Gy (12 - 28 Gy) for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42) of the cases and tumor shrinkage ocurred in 10% (4 in 42) of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS.ConclusionsRS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly acceptable radiological and hormonal control and absence of complications at this early follow-up are consistent with literature.

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Section: Discussionmentioning

confidence: 99%

Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

Castro¹,

Cecílio²,

Canteras³

2010

Radiat Oncol

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“…A radiocirurgia (que pode utilizar raios gama, raios-X e partículas pesadas como prótons) surgiu como uma forma de tratamento que utiliza uma dose única de radiação direcionada ao volume-alvo, evitando, na maior parte das vezes, lesão nos tecidos vizinhos (91) .…”

Section: Tratamento Recuperação Visual E Seguimentounclassified

Correlação entre a densidade capilar da retina peripapilar e macular medidas com a angiotomografia de coerência óptica e as medidas de espessura retiniana e campimetria visual em olhos com atrofia em banda do nervo óptico

Suzuki¹

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Purpose: To compare the circumpapillary and superficial macular vessel density (cpVD and mVDsup) of eyes with temporal visual field (VF) defect and band atrophy (BA) of the optic nerve and normal controls using optical coherence tomography angiography (OCTA) and to verify the association of vessel density parameters with retinal neural loss assessed by conventional optical coherence tomography (OCT) and VF loss. Methods: Thirty-three eyes of 26 patients with BA and 42 eyes of 22 age-matched normal controls underwent OCT + OCTA scanning. cpVD and circumpapillary retinal nerve fiber layer (cpRNFL) thickness were expressed as average and sector measurements. mVDsup and macular ganglion cell complex (mGCC) thickness were calculated as averages and in quadrants and hemiretinas. VF loss was estimated using the 24-2 and the 10-2 protocols. Results: Compared with controls, BA eyes displayed smaller average cpVD and mVDsup values (p < 0.001 and AROC = 0.91 for both). Sectorial measurements were also reduced, especially the nasotemporal sector average cpVD (p < 0.001 and AROC = 0.96) and the nasal inferior retina mVDsup measurements (p < 0.001 and AROC = 0.93). cpVD and mVDsup correlated strongly (p<0,001) with corresponding cpRNFL and mGCC thickness measurements in affected regions (r range: 0.67-0.78 and 0.56-0.76, respectively). Similarly, cpVD and mVDsup parameters correlated significantly with corresponding VF loss (r range: 0.45-0.68). Conclusion: cpVD and mVDsup are significantly reduced in BA eyes compared with controls and are strongly correlated with retinal neural and VF loss. cpVD and mVDsup reduction on OCTA could serve as a surrogate for retinal neural loss in compressive optic neuropathy and might be useful in its management.

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