Gamma Knife Radiosurgery for Functioning Pituitary Adenomas

Kim, S.H.; Huh, Ryoong; Chang, Jin Woo; Park, Y.G.; Chung, Sang Sup

doi:10.1159/000056445

Cited by 84 publications

(55 citation statements)

References 7 publications

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“…Choi et al 8 found that a greater maximum radiation dose was associated with a higher rate of hormonal remission. Kim et al 24 reported a similar finding, and also discovered that patients with larger tumor volumes were more likely to achieve biochemical remission than those with smaller masses. Interestingly, while the maximum radiation dose significantly predicted hormonal remission in these studies, Kim et al, 24 Losa et al, 33 Pollock et al, 47 and Zhang et al 62 found that the marginal radiation dose was not a significant prognostic factor.…”

Section: Endocrinological Remission and Controlmentioning

confidence: 65%

“…Kim et al 24 reported a similar finding, and also discovered that patients with larger tumor volumes were more likely to achieve biochemical remission than those with smaller masses. Interestingly, while the maximum radiation dose significantly predicted hormonal remission in these studies, Kim et al, 24 Losa et al, 33 Pollock et al, 47 and Zhang et al 62 found that the marginal radiation dose was not a significant prognostic factor. In addition, in the studies of Castinetti et al 5 and Jezková et al, 21 preradiosurgical GH and IGF-I levels were found to predict posttreatment outcomes.…”

Section: Endocrinological Remission and Controlmentioning

confidence: 65%

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The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stapleton

Liu

Weiss

2010

FOC

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Growth hormone (GH)–secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.

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Section: Endocrinological Remission and Controlmentioning

confidence: 65%

Section: Endocrinological Remission and Controlmentioning

confidence: 65%

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Stapleton

Liu

Weiss

2010

FOC

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“…The reported tumour control in SRS studies in patients with Cushing's disease was 94% at a corrected median follow-up of 45 months (table 2) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). This compares to the 5-year tumour control rate (progression free survival) in all pituitary adenomas of 91.5% (39)(40)(41)(42), which is worse than reported following fractionated RT even though the tumours treated are smaller.…”

Section: Radiosurgerymentioning

confidence: 79%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

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Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease. RESUMORadioterapia e Radiocirurgia para a Doença de Cushing. Pacientes com doença de Cushing residual ou recorrente recebem radioterapia externa em feixe (RT) com o objetivo de alcançar um controle tumoral prolongado e a normalização dos níveis hormonais elevados. O tratamento é realizado tanto com RT convencional, usando técnicas conformacionais, ou com RT estereotáxica, que é usada tanto como tratamento fracionado (RTF) ou como radiocirurgia em procedimento único (RCU). Descreveremos os aspectos técnicos do tratamento e mostraremos uma revisão sistemática da literatura sobre a eficácia e toxicidade da RT convencional, da RTF e da RCU. Não existem estudos comparando diretamente as diferentes técnicas de radiação, e os resultados reportados são inevitavelmente os de pacientes selecionados pelos investigadores com interesse no tratamento testado. De qualquer maneira, a revisão dos dados publicados sugere que há melhores taxas de controle hormonal e tumoral após RTF em comparação com RCU. O hipopituitarismo representa a complicação tardia mais comumente relatada da RT, vista após todos os tipos de tratamento. Embora a incidência de outros efeitos tardios seja baixa, o risco de a radiação comprometer estrutura...

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“…A assim chamada radiocirurgia pode ser realizada através da gamma knife ou por acelerador linear (LINAC). Estudos iniciais sugerem que o tempo necessário para obtenção da normalização hormonal possa ser abreviado com as novas técnicas (58,59). Apenas maior tempo de observação poderá confirmar se os riscos de tumores radio-induzidos ou o hipopituitarismo secundário serão reduzidos, já que estas complicações podem aparecer com mais de 10 ou 20 anos de seguimento.…”

Section: Inovações Na Radioterapiaunclassified

Tumores hipofisários: opções terapêuticas atuais e perspectivas futuras de tratamento

Musolino

2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 4 Agosto 2003 482 RESUMOA indicação de tratamento dos tumores hipofisários depende das suas características secretórias e volume. Nos prolactinomas, a terapêutica clínica com uso de agonistas dopaminérgicos continua sendo a primeira opção, enquanto nos outros tumores o tratamento cirúrgico ainda é o mais indicado. No entanto, para a acromegalia, a introdução dos análogos da somatostatina com ação prolongada tem aumentado a indicação dessas drogas, inclusive como tratamento primário. O antagonista do GH, pegvisomant, e o desenvolvimento de novos aná-logos específicos para subtipos do receptor da somatostatina são grandes avanços reais e potenciais. No âmbito da cirurgia e radioterapia, novas técnicas também têm sido incorporadas, sempre na busca de melhores resultados associados à menor risco de complicações. Este artigo visa resumir os tratamentos atuais e as perspectivas futuras, como a terapia gênica, para os adenomas hipofisários. The treatment of pituitary tumors depends on its volume and secretory patterns. For prolactinomas, the clinical treatment using dopaminergic agonists is now considered the first choice therapy, whereas for all other pituitary tumors the surgical treatment is still the initial approach. In acromegaly, however, the development of long-action somatostatin analogs has changed the management of this disease, and these drugs have also been considered as first-line therapy. Furthermore, ongoing research on more specific analogs for subtypes of somatostatin receptor and the recently developed GH receptor antagonist pegvisomant, will be new alternatives for acromegalic treatment. Regarding transphenoidal surgery and radiotherapy, new technologies are being developed in search for better results and minor complications. This article summarizes the current treatments and future perspectives, such as gene therapy, for the management of pituitary adenomas.

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Gamma Knife Radiosurgery for Functioning Pituitary Adenomas

Cited by 84 publications

References 7 publications

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

The role of stereotactic radiosurgery in the multimodal management of growth hormone–secreting pituitary adenomas

Radiotherapy and radiosurgery for Cushing's disease

Tumores hipofisários: opções terapêuticas atuais e perspectivas futuras de tratamento

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