Frequency, pattern, and outcome of recurrences after gamma knife radiosurgery for pituitary adenomas

Losa, Marco; Spatola, Giorgio; Albano, Luigi; Gandolfi, Alessandra; Vecchio, Antonella Del; Bolognesi, Angelo; Mortini, Pietro

doi:10.1007/s12020-016-1081-8

Cited by 33 publications

(16 citation statements)

References 24 publications

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“…The tumor regrowth in field was more frequent than out of field (66.7 VS 33.3%) in our study. In the study of Losa et al (18), of the 26 patients, there were 18 patients (69.2%) developed recurrence out of field, which was higher than our study. We found previous surgery was significantly associated with tumor regrowth out of field (p = 0.033).…”

Section: Discussioncontrasting

confidence: 73%

“…The actuarial tumor control rates were 100%, 90%, 90%, 68%, and 68% at 1, 3, 5, 10 and 15 years after repeat GKRS, respectively. In previous studies, 0-9.6% of NFPA patients occurred tumor recurrence after GKRS (11,(13)(14)(15)(16)(17)(18). In a large study of 543 patients with pituitary adenomas by Losa et al (18), there were more patients with NFPA than functioning pituitary adenomas had a tumor recurrence (9.6% VS 4.8%).…”

Section: Discussionmentioning

confidence: 93%

“…The actuarial tumor control rates were 100%, 90%, 90%, 68%, and 68% at 1, 3, 5, 10, and 15 years after repeat GKRS, respectively. In the study of Losa et al (18), 16 of 26 NFPA patients received GKRS as further therapy, and 15 of them had final outcomes. With median follow-up of 68 (range, 14-167) months in these patients, tumor improving in 1 patient (6.7%), remained stable in 13 patients (86.7%), only 1 patient (6.7%) with tumor progression.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor regrowth is the most common type of treatment failure in GKRS for NFPAs. Most publications reported tumor recurrence in 0-9.6% of treated patients with NFPA after GKRS (11,(13)(14)(15)(16)(17)(18). However, there are few studies reporting the characteristics of tumor regrowth after GKRS and outcomes of repeat GKRS.…”

Section: Introductionmentioning

confidence: 99%

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Characteristic of Tumor Regrowth After Gamma Knife Radiosurgery and Outcomes of Repeat Gamma Knife Radiosurgery in Nonfunctioning Pituitary Adenomas

Li¹,

Wu²,

Quan³

et al. 2021

Front. Oncol.

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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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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characteristic of Tumor Regrowth After Gamma Knife Radiosurgery and Outcomes of Repeat Gamma Knife Radiosurgery in Nonfunctioning Pituitary Adenomas

Li¹,

Wu²,

Quan³

et al. 2021

Front. Oncol.

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“…Another study by Sheehan and colleagues indicated that GKRS treatment of patients with CD after failed TSS could result in 63% of the patients achieving normal 24-h urinary free cortisol (UFC) levels; however, 16% of the patients obtained new endocrine deficiencies (27). Losa et al (28) conducted another retrospective analysis of patients with pituitary adenoma treated by GKRS and found that patients with NFPAs have more frequent recurrence of disease than patients with hormone-secreting adenomas (9.6 vs. 4.8%). The 10-year progression-free survival in patients with NFPAs was 78.7%, which is much lower than that in patients in hormone-secreting adenomas (93.3%).…”

Section: Management Of Refractory Pasmentioning

confidence: 99%

The Treatment of Refractory Pituitary Adenomas

Dai

Liu

et al. 2019

Front. Endocrinol.

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Refractory pituitary adenomas (PAs) are defined as aggressive-invasive PAs characterized by a high Ki-67 index, rapid growth, frequent recurrence, and resistance to conventional treatments. It is notoriously difficult to manage refractory PAs because the efficacy of current therapeutic options is limited. The purpose of this review is to address currently employed and promising therapeutic strategies for the treatment of refractory PAs. Except for prolactinomas, neurosurgery is the first-line option, but most refractory PAs often recur or re-grow after initial surgery and require further treatments. Medical therapy, radiotherapy and re-operation are explored when surgery has failed to completely resect tumors; however, refractory PAs are usually resistant to these treatments. As a salvage treatment, temozolomide (TMZ) has shown promising results and is currently used for all types of refractory PAs. However, not all refractory PAs are responsive to TMZ treatment, and some of these PAs are resistant to TMZ. Although targeted therapies such as vascular endothelial growth factor, epidermal growth factor and mTOR inhibitors have also been used to treat refractory PAs, the effectiveness of these targeted therapies is still not known due to a lack of data from randomized prospective trials. As a novel therapeutic method, cancer immunotherapy is a promising strategy for the treatment of refractory PAs, but further preclinical research and clinical trials are needed to assess the efficacy of this new approach. In summary, early identification and a multidisciplinary approach are required to treat refractory PAs.

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