Stereotactic Radiosurgery for Pituitary Adenomas: A Review of the Literature

Abstract

Although surgical resection typically is the primary treatment modality, stereotactic radiosurgery offers safe and effective treatment for recurrent or residual pituitary adenomas. In rare instances, radiosurgery may be the best initial treatment for patients with pituitary adenomas. Refinements in the radiosurgical technique will likely lead to improved outcomes.

Outcome of radiotherapy for pituitary adenomas

“…Colin et al 7 reported no visual complications in 110 patients treated with 50.4 Gy in 1.8 Gy per fraction. Witt et al 9 and Laws et al 10 11 Twice daily fractionation of 1.2 Gy each is also reported in order to reduce the optic pathway complications. 5 Our study shows the visual complication rate of 5.3% and 10% more chances of developing visual complication for the conventional technique as compared to the SRT technique probably due to the possibility of hot spot on the chiasm and visual apparatus.…”

Clinically nonfunctioning pituitary adenoma growth after radiosurgery

“…Benign tumors of the CNS are candidates to perform RS 1 . It has emerged as a therapeutic option for clinically nonfunctioning pituitary adenomas (CNFPA), associated with effective control of tumor growth and few complications 1 .…”

“…Benign tumors of the CNS are candidates to perform RS 1 . It has emerged as a therapeutic option for clinically nonfunctioning pituitary adenomas (CNFPA), associated with effective control of tumor growth and few complications 1 . About 30% of pituitary adenomas are classified as CNFPA, and patients with this tumor usually have clinical symptoms, such as headaches, visual loss, hypopituitarism and, less commonly, pituitary apoplexy 2 .…”

“…These tumors often develop slowly, but diagnosis tends to be late. Surgery is the primary treatment option, preferably transsphenoidal, complemented or not by radiotherapy (RT) or RS 1 . In cases of tumor residues, the therapeutic approach remains controversial.…”

“…Efficacy and safety of RS in CNFPA have not been evaluated as adequately as in functioning pituitary adenomas 1 . In three series of patients, with a follow-up period longer A B than 48 months, RS was able to control tumor growth in 93 to 96% of the cases [1][2][3] .…”