Preservation of visual fields after peri-sellar gamma-knife radiosurgery

Ove, Roger; Kelman, Shalom E.; Amin, Pradip; Chin, Lawrence S.

doi:10.1002/1097-0215(20001220)90:6<343::aid-ijc6>3.0.co;2-h

Cited by 76 publications

(41 citation statements)

References 30 publications

(41 reference statements)

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“…The arteries are often in direct contact with the chiasm. 8) In the present case, MR imaging found no lesions in nearby structures such as the pituitary gland, stalk, and hypothalamus. The intraoperative findings also revealed that the pituitary stalk was normal, and the clinical symptoms included only visual dysfunction, and not diabetes insipidus or hypopituitarism.…”

Section: Discussionsupporting

confidence: 48%

Solitary Metastatic Tumor Within the Optic Chiasm -Case Report-

Arai

Morishita

Hanada

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 61-year-old female, previously treated for lung cancer, presented with a rare case of metastasis directly to the optic chiasm manifesting as visual deficits. Magnetic resonance imaging revealed a suprasellar mass similar to an optic glioma. At surgery, the optic chiasm appeared swollen with hypervascularity over the surface. The bilateral optic nerves and the pituitary stalk appeared normal. A small incision was made on the superior surface of the chiasm and biopsy specimens were taken. The histological diagnosis was adenocarcinoma, which was consistent with the primary lung cancer. She received whole brain irradiation, resulting in mild improvement of her vision. Suprasellar metastatic tumors to the pituitary gland, pituitary stalk, and hypothalamus are well documented, but solitary metastasis within the optic chiasm should be considered as one of several differential diagnoses of suprasellar tumors, in patients with or without a history of treated cancer.

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Section: Discussionsupporting

confidence: 48%

Solitary Metastatic Tumor Within the Optic Chiasm -Case Report-

Arai

Morishita

Hanada

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…Three of the four patients received more than 8 Gy to the anterior optic apparatus, prompting the authors to agree with previous reports that the optic nerves and chiasm can tolerate a maximal radiation dose of 8 Gy, 15,31,52 although others have reported safe doses in the range of 10 to 12 Gy. 26,34,36,49 Other risk factors for the development of RON include previous radiation therapy, 10 pretherapy visual loss, 25 tumor size greater than 10 mm, 12,50 and isocenters within 5 mm of the visual pathways. 50 Stafford, et al, 49 have estimated that the incidence of RON following SRS is 1.7% if the dose to the chiasm is less than 8 Gy, 1.8% if it is between 8 and 10 Gy, and 6.9% if it is greater than 12 Gy.…”

Section: Complications Of Srsmentioning

confidence: 99%

Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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The most common cause of Cushing syndrome is Cushing disease, in which hypercortisolism is produced by a functional adrenocorticotropic hormone–producing adenoma of the anterior pituitary gland. The common therapies available include microsurgical resection, conventional fractionated radiotherapy, and stereotactic radiosurgery (SRS). In this article the authors review the indications, results, and complications associated with SRS in the treatment of Cushing disease. In as many as 90% of patients SRS results in disease remission, which is defined as a normal 24-hour urinary free cortisol level and a normal or subnormal morning serum cortisol level. Although in most patients who are subsequently cured a marked decrease in the serum cortisol level is demonstrated within 3 months after treatment, a biochemical cure may be delayed up to 3 years in some cases. Complications following SRS for pituitary adenomas are uncommon, particularly in patients with microadenomas, which are most commonly seen in Cushing disease. The most common complication is hypopituitarism, which occurs in up to 50% of patients with a mean latency period of 5 years. Radiation-induced optic neuropathy has been reported in less than 2% of cases and induction of a secondary neoplasm in less than 1% of cases. For patients with Cushing disease, the rate of endocrinological cure following SRS appears to be similar to that attained using microsurgical resection. In contrast to surgery, SRS has the benefit of being noninvasive and associated with a very low incidence of diabetes insipidus, although hypopituitarism may be more common with SRS. With continued follow-up patient reviews and additional experience with SRS, it may become possible to make more definitive statements regarding SRS as the initial treatment for patients with Cushing disease.

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“…28 Scientific literature supports the efficacy and safety of single-fraction radiosurgical ablation for the treatment of Pituitary adenomas. 29,30 Tumor control rates following Gamma Knife SRS is about 92-97%. 20,21 In a series from Stanford University, 23 Cyberknife SRS was delivered in 2-5 fractions to a cumulative average marginal dose of 20 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the major challenge for safely delivering SRS is that single fraction tolerance dose of the chiasm is 8 Gy, while the therapeutic dose for the adenoma is 15 Gy. 29,31 There are limitations to the linear-quadratic model, which does not integrate many of the biological effects radiation present in vivo, such as tumor heterogeneity, hypoxia, and micro-vascular response to irradiation. 32 Even so, histopathological evaluation of pituitary adenoma specimens following either SRS or conventionally fractionated radiation therapy has shown a more potent radiobiological effect of SRS.…”

Section: Discussionmentioning

confidence: 99%

Hypo-fractionated stereotactic radiotherapy (HF-SRT) for peri-optic pituitary adenomas – Early results of a novel experience

Bhatt

Dragun

Bhatt

et al. 2011

JST

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Background/ObjectiveTo report our early experience with a novel Hypo-fractionated Stereotactic Radiotherapy (HF-SRT) regimen in the treatment of pituitary adenomas located in close proximity to the optic apparatus. Methods Twelve patients were treated using HF-SRT-total doses of 35-40 Gy in 7-10 fractions (4-5 Gy/fx). Sixty seven percent received 40 Gy in 10 fractions. Doses were prescribed to the 80-95% isodose line when the technique was cone-based, and to 85-95% of the Planning Target Volume (PTV) when IMRT-based. The end-points were visual function preservation, and local control as defined by follow-up MRI and/or biochemical control.

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Preservation of visual fields after peri-sellar gamma-knife radiosurgery

Cited by 76 publications

References 30 publications

Solitary Metastatic Tumor Within the Optic Chiasm -Case Report-

Solitary Metastatic Tumor Within the Optic Chiasm -Case Report-

Stereotactic radiosurgery for Cushing disease

Hypo-fractionated stereotactic radiotherapy (HF-SRT) for peri-optic pituitary adenomas – Early results of a novel experience

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