Radiotherapy of Parasellar Tumours

Abstract

Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects.

Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

“…The studies reported the highest marginal dose were, in fact, those associated with the best tumor control rate and PFS over time. Due to the basal anatomical location of these tumors and their close proximity/contact to the optic system, dose reduction to decrease the risk of new or further optic neuropathy may be necessary [ 7 ]. Losa et al suggested that hypofractionated GK is a safe and effective treatment allowing to prescribe high radiation dose to the tumor minimizing the risk of radiation-induced optic injury as well (see 4.4 Multisession Gamma Knife radiosurgery for pituitary tumors) [ 53 ].…”

“…GK allows to precisely deliver high doses of radiation to small targets minimizing the volume of normal brain structures irradiated to high doses, such as the optic pathway; it is thus frequently employed in patients with pituitary tumors. GK is usually given in single fraction or, less frequently, in a reduced number of fractions (from 2 to a maximum of 5) [ 6 , 7 ].…”

Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

“…However, side effects of irradiation are delayed and may include hypothalamic complications ( 9 ). Among modern techniques, proton therapy may take an increasing place in the treatment of residual or recurrent CP because of the dosimetric characteristics of protons and limited off-target toxicity ( 2 , 85 ).…”

The Challenging Management of Craniopharyngiomas in Adults: Time for a Reappraisal?

“…They include conventional external radiotherapy, proton beam therapy, stereotactic radiotherapy, and radiosurgery. Usually, these modalities are used in combination with partial surgery, or more rarely alone [ 21 , 22 ]. When combined with surgery, radiation techniques can be employed in two different settings: immediately after an incomplete surgery (partial surgery decided by the surgeon), or after surgery, during the follow-up of the patient, when a new tumor remnant appears, or if a previously known tumor remnant becomes progressive (radiotherapy as a second step).…”