External radiotherapy of pituitary adenomas

Zierhut, Dietmar; Flentje, Michael; Adolph, J; Erdmann, Johannes; Raue, Friedhelm; Wannenmacher, M

doi:10.1016/0360-3016(95)00071-6

Cited by 150 publications

(70 citation statements)

References 43 publications

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“…But still the fractions of patients developing loss of pituitary axes following GKRS seems to be lower than reported for conventional radiotherapy (50-100%) (11,12). We have not found any papers describing the effect of repeated transsphenoidal surgery for NS on pituitary function.…”

Section: Discussionmentioning

confidence: 64%

Gamma knife stereotactic radiosurgery of Nelson syndrome

Vik-Mo

Øksnes

Pedersen

et al. 2009

European Journal of Endocrinology

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Objective: Gamma knife radiosurgery (GKR) can be used as primary or adjuvant therapy for the treatment of an ACTH-producing pituitary tumor after bilateral adrenalectomy, called Nelson syndrome (NS). We have examined the effect of GKR on tumor growth and ACTH-hypersecretion, and characterized the adverse events of this treatment in patients with NS. Design: Cross-sectional follow-up study. First, retrospective data pre-and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. Subjects: Ten patients treated with GKR for NS after previous bilateral adrenalectomy. The mean followup was 7 years. No patient was lost to follow-up. Results: Tumor growth was stopped in all patients. The ACTH levels declined in eight patients, and normalized in one patient. There was a significant drop in ACTH levels, with a half-time of 2.8 years.No patient developed visual field defects or any other cranial nerve dysfunction as a result of treatment. Four patients started hormone substitution therapy during the follow-up period. The substitution therapy of three pituitary axes present at GKR treatment could be stopped during the same period. One patient developed a glioblastoma in the left parieto-occipital region 14 years after GKR, far from the field of treatment. As the radiation level was below 1Gy to this area, it is unlikely that the GKR treatment itself induced the malignant tumor. Conclusion: In patients with NS, GKR is an effective adjuvant treatment, carrying relatively few adverse effects. Although the risk of developing a secondary neoplasia after GKR is present, it is probably extremely low.

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Section: Discussionmentioning

confidence: 64%

Gamma knife stereotactic radiosurgery of Nelson syndrome

Vik-Mo

Øksnes

Pedersen

et al. 2009

European Journal of Endocrinology

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“…There are few published data on the frequency of long-term anterior pituitary hormone deficiencies post-RT for paediatric CD. The outcome of pituitary irradiation in CD has been reported in a number of small studies with hypopituitarism being a recognised complication (18)(19)(20). Storr et al (11) previously described the efficacy of RT in seven children treated by pituitary RT post-TSS in our centre, but the follow-up was relatively brief in terms of other pituitary deficiencies.…”

Section: Introductionmentioning

confidence: 91%

Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy

Chan

Storr

Plowman³

et al. 2007

eur j endocrinol

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Background/objective: Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing's disease (CD). Although the short-term effects of pituitary RT are well documented, there are less data on possible long-term sequelae. We report the long-term anterior pituitary function in a cohort of paediatric CD patients treated with pituitary RT. Patients and methods: Between 1983 and 2006, 12 paediatric CD patients (10 males and 2 females) of mean age 11.4 years at diagnosis (range 6.4-17.4) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of 12, 11 patients were cured by RT (cure interval 0.13-2.86 years) defined by mean serum cortisol of !150 nmol/l on 5-point day curve and midnight sleeping cortisol of !50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0-17.6 years. The mean follow-up from the completion of RT was 10.5 years (6.6-16.5). Results: At a mean of 1.0 year (0.11-2.54) following RT, GH deficiency (peak GH !1-17.9 mU/l) was present in five out of six patients. On retesting at a mean of 9.3 years (7.6-11.3) after RT, three out of four patients were GH sufficient (peak GH 19.2-50.4 mU/l). Other anterior pituitary functions including serum prolactin in five out of six patients were normal on follow-up. All the six patients had testicular volumes of 20-25 ml at the age of 14.5-28.5 years. Conclusion: This series of patients illustrates the absence of serious long-term pituitary deficiency after RT and emphasises the importance of continued surveillance.

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“…Long-term tumor control rates of 90% have been reported for fractionated radiotherapy, 13,78 as well as for stereotactic radiosurgery such as Gamma Knife surgery (GKS). 43,60,67 The peak of tumor size reduction is seen about 3 years after radiotherapy, and volume reductions of 50% have been described within 5 years.…”

Section: 21mentioning

confidence: 99%

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Berkmann

Schlaffer

Nimsky

et al. 2014

JNS

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Object. The loss of anatomical landmarks, frequently invasive tumor growth, and tissue changes make transsphenoidal reoperation of nonfunctioning pituitary adenomas (NFAs) challenging. The use of intraoperative MRI (iMRI) may lead to improved results. The goal of this retrospective study was to evaluate the impact of iMRI on transsphenoidal reoperations for NFA.Methods. Between September 2002 and July 2012, 109 patients underwent reoperations in which 111 transsphenoidal procedures were performed and are represented in this study. A 1.5-T Magnetom Sonata Maestro Class scanner (Siemens) was used for iMRI. Follow-up iMRI scans were acquired if gross-total resection (GTR) was suspected or if no further removal seemed possible.Results. Surgery was performed for tumor persistence and regrowth in 26 (23%) and 85 (77%) patients, respectively. On the initial iMRI scans, GTR was confirmed in 19 (17%) patients. Remnants were located as follows: 65 in the cavernous sinus (71%), 35 in the suprasellar space (38%), 9 in the retrosellar space (10%). Additional resection was possible in 62 (67%) patients, resulting in a significant volume reduction and increased GTR rate (49%). The GTR rates of invasive tumors on initial iMRI and postoperative MRI (poMRI) were 7% and 25%, respectively. Additional remnant resection was possible in 64% of the patients. Noninvasive tumors were shown to be totally resected on the initial iMRI in 31% of cases. After additional resection for 69% of the procedures, the GTR rate on poMRI was 75%. Transcranial surgery to resect tumor remnants was indicated in 5 (5%), and radiotherapy was performed in 29 (27%) patients. After GTR, no recurrence was detected during a mean follow-up of 2.2 ± 2.1 years.Conclusions. The use of iMRI in transsphenoidal reoperations for NFA leads to significantly higher GTR rates. It thus prevents additional operations and reduces the number of tumor remnants. The complication rates do not exceed the incidences reported in the literature for primary transsphenoidal surgery. If complete tumor resection is not possible, iMRI guidance can facilitate tumor volume reduction. (http://thejns.org/doi/abs/10.3171/2014.6.JNS131994) key WorDS • pituitary adenoma • intraoperative MRI • reoperation • tumor recurrence • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: DI = diabetes insipidus; FSH = follicle-stimulating hormone; GKS = Gamma Knife surgery; GTR = gross-total resection; iMRI = intraoperative MRI; LH = luteinizing hormone; NFA = nonfunctioning pituitary adenoma; poMRI = postoperative MRI; VA = visual acuity; VF = visual field. J Neurosurg / Volume 121 / November 2014Intraoperative MRI for transsphenoidal reoperations 1167 ly.29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear. The aim of this retrospective study was to evaluate the impact of iMRI on the extent of transsphenoidal reoperations in patients presenting with recurrent or persisting NFA. Methods Patient Population and Data Asse...

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External radiotherapy of pituitary adenomas

Cited by 150 publications

References 43 publications

Gamma knife stereotactic radiosurgery of Nelson syndrome

Gamma knife stereotactic radiosurgery of Nelson syndrome

Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

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