Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas: results from a 26-year experience

Yu, Jinxiu; Li, Yanli; Quan, Tingting; Li, Xi; Peng, Chao; Zeng, Jiamin; Liang, Shunyao; Huang, Minyi; He, Yong; Deng, Yao

doi:10.1007/s12020-020-02260-1

Cited by 17 publications

(9 citation statements)

References 42 publications

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“…The differences in PFSs between meningioma and non-meningioma tumors possibly re ected differences in tumor biology, which might be due to selection bias in that most meningiomas are postoperative cases. In the literature, tumor control rates were reported to be 77-100% in TS at median observation periods of 27-91 months, 89-100% in non-functioning PA at 36-67 months, and 100% in CH at 30-40 months [13][14][15][16][17][18][23][24][25][26][27][28]. Our data are comparable to these studies.…”

Section: Discussionsupporting

confidence: 88%

Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus

et al. 2022

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PurposeStereotactic radiosurgery (SRS) is an effective and less invasive therapeutic option for cavernous sinus (CS) tumors. However, its long-term effectiveness and neurological outcomes have yet to be fully elucidated. We aimed to examine the long-term outcomes of SRS for CS tumors. MethodsOverall, 127 patients with benign CS tumors, including 91 with meningioma, 14 with trigeminal schwannoma (TS), 14 with non-functioning pituitary adenoma (PA), and eight with cavernous hemangioma (CH), treated with SRS at our institution from 1990 to 2018, were included. Tumor control and functional preservation/recovery were evaluated in detail. ResultsThe mean post-SRS follow-up period was 102 months. The progression-free survivals (PFSs) were 97% at 5 years, 90% at 10 years, and 88% at 15 years for the entire cohort; 96% at 5 years and 87% at 10 years for meningiomas; and 100% at 10 years for the other tumors. No signi cant difference was observed among the tumor types (log-rank test; meningioma vs. TS, p = 0.232, meningioma vs. PA, p = 0.297, meningioma vs. CH, p = 0.277). Improvement in cranial nerve (CN) function was observed in 35 (27%) patients. TSs tended to show CN improvements more often than meningiomas did (total improvements, 62% vs. 23%; p = 0.004, eye movement function, 100% vs. 20%; p = 0.002). Deterioration, or development of new CN de cits, was observed in 11 (9%) patients. ConclusionSRS provides durable tumor control and contributes to su cient preservation of CN function.

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Section: Discussionsupporting

confidence: 88%

Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus

et al. 2022

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“…This was consistent with previous reports, which ranged between 21 and 120 months after SRS. 8,11,22,[26][27][28] The time to development of new endocrinopathy may also depend upon the affected hormone. In a cohort of 48 non-functioning adenoma patients treated with SRS, Gopalan et al reported early onset of cortisol de ciency at a mean of 27 months, compared to gonadotropin de ciency, which occurred a mean of 120 months after SRS.…”

Section: Discussionmentioning

confidence: 99%

Effect of distance from target on hypopituitarism after stereotactic radiosurgery for pituitary adenomas

Ironside

Snyder

et al. 2022

J Neurooncol

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IntroductionDelayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas. The aim of this study was to investigate the relationship between the distance from the hypothalamicpituitary axis to the treatment target and anterior pituitary function preservation after SRS. MethodsBetween 2007 and 2020, consecutive adult patients who underwent single-session SRS for pituitary adenomas with ³6 months of follow-up were included. Distance measurements between hypothalamic-pituitary axis structures and the SRS target volume were quanti ed on MRI. The primary outcome was anterior pituitary function preservation.Outcomes were compared using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. ResultsThe study cohort comprised 224 patients, who were categorized by preservation (n=168) and no preservation (n=56) of anterior pituitary function after SRS. Independent predictors of anterior pituitary function preservation were a greater distance between the center of the pituitary gland and center of the SRS target (OR=1.101 [1.000-1.213], p=0.050), and a shorter clinical follow-up duration (OR=0.985 [0.977-0.993], p<0.0001). The adjusted AUROC for the distance from the center of the pituitary gland and center of the SRS target in predicting anterior pituitary function preservation was 0.595. The sensitivity, speci city, positive predictive value and negative predictive value in predicting anterior pituitary function preservation at the optimal cut-off distance of 15mm were 30.0%, 88.0%, 89.9% and 26.2%, respectively. ConclusionsGreater distance between the normal pituitary gland and the SRS target is associated with anterior pituitary function preservation and increasing this distance should be a goal of adenoma resection. Larger prospective, multi-center studies are necessary to corroborate this nding and establish the effects of distance on hypopituitarism after SRS for pituitary adenomas.

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“…Gamma Knife radiosurgery (GKRS) which has advantages of a highly precise, better dose conformity and focused delivery of radiation in a single session, is one of the best radiation technique and essential part in the treatment of pituitary tumors. As previous publications reported (4)(5)(6)(7)(8)(9)(10)(11)(12), GKRS has been proved to offer a high tumor control rate of 83-95% and a low new-onset hypopituitarism rate of 9-32% for pituitary adenomas. Treatment failure after GKRS for NFPAs consists of progressive cystic enlargement, tumor apoplexy and tumor regrowth (4).…”

Section: Introductionmentioning

confidence: 87%

“…Radiotherapy is recommended for residual or recurrent NFPAs (3). When patients are not candidate to surgical resection because of significant comorbidities, an advanced age or cavernous sinus invasion, radiotherapy may be used as primary management (4). Gamma Knife radiosurgery (GKRS) which has advantages of a highly precise, better dose conformity and focused delivery of radiation in a single session, is one of the best radiation technique and essential part in the treatment of pituitary tumors.…”

Section: Introductionmentioning

confidence: 99%

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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Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas: results from a 26-year experience

Cited by 17 publications

References 42 publications

Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus

Long-term outcomes of stereotactic radiosurgery for skull base tumors involving the cavernous sinus

Effect of distance from target on hypopituitarism after stereotactic radiosurgery for pituitary adenomas

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

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