A single centre’s experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the Linear Accelerator (Linac)

Wilson, Peter; De-loyde, Katie; Jl, Williams; Smee, Robert

doi:10.1016/j.jocn.2011.07.025

Cited by 43 publications

(32 citation statements)

References 13 publications

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“…Most studies involved smaller numbers of patients, with 2.5-6.5 years' follow-up [58][59][60][61][62][63][64][65][66][67][68]. Results were generally similar to those of classic RT, with tumoral control achieved in 90-100% of cases at 5 years.…”

Section: Radiosurgerymentioning

confidence: 99%

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Post-surgical management of non-functioning pituitary adenoma

Cortet‐Rudelli

Bonneville

Borson‐Chazot

et al. 2015

Annales d'Endocrinologie

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Post-surgical surveillance of non-functioning pituitary adenoma (NFPA) is based on magnetic resonance imaging (MRI) at 3 or 6 months then 1 year. When there is no adenomatous residue, annual surveillance is recommended for 5 years and then at 7, 10 and 15 years. In case of residue or doubtful MRI, prolonged annual surveillance monitors any progression. Reintervention is indicated if complete residue resection is feasible, or for symptomatic optic pathway compression, to create a safety margin between the tumor and the optic pathways ahead of complementary radiation therapy (RT), or in case of post-RT progression. In case of residue, unless the tumor displays elevated growth potential, it is usually recommended to postpone RT until progression is manifest, as efficacy is comparable whether treatment is immediate or postponed. The efficacy of the various RT techniques in terms of tumor volume control is likewise comparable. RT-induced hypopituitarism is frequent, whatever the technique. The choice thus depends basically on residue characteristics: size, delineation, and proximity to neighboring radiation-sensitive structures. Reduced rates of vascular complications and secondary brain tumor can be hoped for with one-dose or hypofractionated stereotactic RT, but there has been insufficient follow-up to provide evidence. Somatostatin analogs and dopaminergic agonists have yet to demonstrate sufficient efficacy. Temozolomide is an option in aggressive NFPA resistant to surgery and RT.

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Section: Radiosurgerymentioning

confidence: 99%

“…Wilson et al [68], in a recent study, compared results in conventional fractionated RT, LINAC stereotactic radiosurgery and fractionated stereotactic RT. Allowing for various inclusion biases (historic series for conventional fractionated RT, smaller tumors remote from the optic pathways for stereotactic radiosurgery, etc.)…”

Section: Cyberknife Radiotherapymentioning

confidence: 99%

Post-surgical management of non-functioning pituitary adenoma

Cortet‐Rudelli

Bonneville

Borson‐Chazot

et al. 2015

Annales d'Endocrinologie

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“…A summary of previously reported studies of stereotactic radiosurgery for nonfunctioning pituitary adenomas has been reproduced in Table 6. 4,14,17,20,[23][24][25][26]28,29,33,35,37,40,41,45,[47][48][49][50][51]53,56,61,63,65 While stereotactic radiosurgery confers a high rate of tumor control (approximately 90%) and a low rate of neurological deficits, the promising results of adjuvant GKRS are largely byproducts of single-center retrospective studies. 4,17,20,[23][24][25][26]28,29,33,35,37,41,45,[47][48][49]51,55,61,65 More recently, a large-scale multicenter study proposed a strong benefit-to-risk ...…”

mentioning

confidence: 99%

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

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N oNfuNctioNiNg pituitary adenomas constitute approximately 15% to 30% of pituitary tumors 10,16 and typically present with symptoms of mass effect, including vision loss, headaches, and hypopituitarism from compression of the normal pituitary gland. Selective adenomectomy via a transsphenoidal approach remains the primary treatment modality by providing decompression and the prospect for cure. Complete resection rates vary significantly and can be limited due to tumor size and propensity for microscopic invasion of the surrounding structures. 2,5,31,32,43,56 Previously reported long-term outcomes following transsphenoidal surgery for nonfunctioning macroadenomas suggest that even gross-total resection carries a 10% to 20% rate of tumor recurrence at distant follow-up. 6,8,9,13,19,21,34,43,46,58,64,66 Subtotal resection without adjuvant treatment reportedly results in the progression of adenoma growth in 50% to 60% of patients within 10 years of surgery. 9,22,34,43,46,48 For these reasons, patients with nonfunctioning tumors may undergo secondary operations and/ or adjuvant radiotherapy for the treatment of residual or progressive disease. obJective Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. methods This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. results Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. coNclusioNs Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared w...

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“…Colin et al 7 reported no visual complications in 110 patients treated with 50.4 Gy in 1.8 Gy per fraction. Witt et al 9 and Laws et al 10 11 Twice daily fractionation of 1.2 Gy each is also reported in order to reduce the optic pathway complications. 5 Our study shows the visual complication rate of 5.3% and 10% more chances of developing visual complication for the conventional technique as compared to the SRT technique probably due to the possibility of hot spot on the chiasm and visual apparatus.…”

Section: Visualmentioning

confidence: 99%