Safety and efficacy of fractionated stereotactic radiotherapy and stereotactic radiosurgery for treatment of pituitary adenomas: A systematic review and meta-analysis

Li, Xuezhen; Li, Yanbin; Cao, Yang; Li, Peiliang; Liang, Bo; Sun, Jidian; Feng, Enshan

doi:10.1016/j.jns.2016.11.024

Cited by 32 publications

(13 citation statements)

References 32 publications

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“…Let us set the record straight: there are no randomized controlled trials showing the superiority of RT compared to a conservative approach after surgery for nonfunctioning pituitary adenomas. There are also no randomized controlled trials comparing different RT procedures (conventional RT, SRS, FSRT) (5). For most drugs, this would be a sufficient argument not to use them in routine clinical practice.…”

Section: Lack Of Randomized Controlled Trialsmentioning

confidence: 99%

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

Chanson

Dormoy

Dekkers

2019

European Journal of Endocrinology

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Surgery is the treatment of choice for non-functioning pituitary macroadenomas (NFPAs). In cases of postoperative remnant growth or tumor recurrence, radiotherapy (RT) can be considered. The role of RT in the postoperative management of NFPAs is still debated. The main arguments against routine use of RT are the lack of randomized controlled trials, the use of clinically irrelevant endpoints in most studies on RT, the benign character of the condition, the potential for side effects of RT, and the option to apply RT at a later stage. However, because of its excellent efficacy in inhibiting tumor growth, reducing tumor volume and improving any existing visual defects, and as its side effects seem to be limited compared to the benefits provided, RT keeps a place in the management of NFPAs when a tumor remnant persists, particularly if it is invasive and displays high proliferation markers, if surveillance shows a relevant increase in tumor volume or if the tumor is close to the optic chiasm. The size of the remnant, its vicinity with the optic pathways, and the potential risk to healthy surrounding tissues need to be considered when deciding on an RT procedure.

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Section: Lack Of Randomized Controlled Trialsmentioning

confidence: 99%

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

Chanson

Dormoy

Dekkers

2019

European Journal of Endocrinology

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“…No study have specifically addressed the outcome of RT in older patients with either secreting or nonsecreting pituitary adenomas, and acoustic neuromas; however, data reported in large retrospective studies and systematic reviews show similar local control and toxicity between young and older patients after either SRS or FSRT [124–142]. Single-fractions doses of 13–16 Gy and 20–28 Gy are usually employed for non-functioning and secreting pituitary adenomas [124, 125, 129–134], respectively, and of 12–14 Gy for acoustic neuromas [135, 137, 139–142]. Hypofractionated RT and FSRT using doses of 21–25 Gy in 3–5 fractions and 45–54 Gy in 25–30 daily fractions of 1.8 Gy, respectively, are frequently employed for large tumors involving the optic pathway or compressing the brainstem [126–128, 133–136, 138].…”

Section: Benign Tumorsmentioning

confidence: 99%

Radiation therapy for older patients with brain tumors

Minniti

Filippi

Osti³

et al. 2017

Radiat Oncol

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The incidence of brain tumors in the elderly population has increased over the last few decades. Current treatment includes surgery, radiotherapy and chemotherapy, but the optimal management of older patients with brain tumors remains a matter of debate, since aggressive radiation treatments in this population may be associated with high risks of neurological toxicity and deterioration of quality of life. For such patients, a careful clinical status assessment is mandatory both for clinical decision making and for designing randomized trials to adequately evaluate the optimal combination of radiotherapy and chemotherapy.Several randomized studies have demonstrated the efficacy and safety of chemotherapy for patients with glioblastoma or lymphoma; however, the use of radiotherapy given in association with chemotherapy or as salvage therapy remains an effective treatment option associated with survival benefit. Stereotactic techniques are increasingly used for the treatment of patients with brain metastases and benign tumors, including pituitary adenomas, meningiomas and acoustic neuromas. Although no randomized trials have proven the superiority of SRS over other radiation techniques in older patients with brain metastases or benign brain tumors, data extracted from recent randomized studies and large retrospective series suggest that SRS is an effective approach in such patients associated with survival advantages and toxicity profile similar to those observed in young adults. Future trials need to investigate the optimal radiation techniques and dose/fractionation schedules in older patients with brain tumors with regard to clinical outcomes, neurocognitive function, and quality of life.

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“…Patients with the pituitary adenomas are commonly treated with either single fraction SRS or hypofractionated SRS with similar rates of efficacy in tumor control and prevalence in new-onset hypopituitarism. Rates of hypopituitarism vary but are reported to be as high as 66% in conventional radiotherapy and significantly lower with stereotactic radiosurgery 5-37% [35][36][37][38][39].…”

Section: Hypopituitarism Induced By Radiationmentioning

confidence: 99%

Toxicity of Cranial and Spinal Cord Irradiation

Naziri¹,

DiBiase²

2020

Brain and Spinal Tumors - Primary and Secondary

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Along with surgery and chemotherapy, radiation therapy is an essential treatment option for metastatic and primary tumors of the central nervous system. Radiation toxicity may be compartmentalized into three subcategories including acute toxicities, early-delayed and late delayed effects. Radiation induced toxicity spans from self-limiting fatigue to more serious delayed side effects of radionecrosis. Stereotactic radiosurgery has recently emerged as a highly focused delivery method of tumoricidal irradiation with promising results compared to whole brain irradiation in many cases. Recognizing and understanding toxicity from cranial irradiation can help guide therapy as ever evolving new technologies develop within this integral component of cancer treatment.

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Safety and efficacy of fractionated stereotactic radiotherapy and stereotactic radiosurgery for treatment of pituitary adenomas: A systematic review and meta-analysis

Cited by 32 publications

References 32 publications

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas

Radiation therapy for older patients with brain tumors

Toxicity of Cranial and Spinal Cord Irradiation

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