Target delineation and optimal radiosurgical dose for pituitary tumors

Minniti, Giuseppe; Osti, Mattia Falchetto; Niyazi, M.

doi:10.1186/s13014-016-0710-y

Cited by 72 publications

(42 citation statements)

References 143 publications

(240 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In most centers, a margin of 0 to 1 mm is generally used for GTV to the planning tumor volume (PTV) expansion. 37 Discrimination between the lesion and the normal pituitary was difficult to perform in our patient with LH, and the PTV took into account potential microscopic lymphocytic infiltration. The target for SRS in our patient was the entire intrasellar area, and a 15-Gy marginal dose was used.…”

Section: Discussionmentioning

confidence: 93%

“…SRS is a radiation therapy technique that allows more precise target localization, accurate dose delivery, and a reduced amount of normal tissue treated with high doses of radiation compared with conventional radiotherapy. 37 This technique precisely delivers a high dose of irradiation to welldefined small to moderate-volume targets using either singlefraction or multi-fraction SRS (2-5 fractions). The most common delivery systems used for SRS include the cobalt-50 system Gamma Knife, the CyberKnife Robotic Radiosurgery System, or a modified conventional radiotherapy machine (LINAC).…”

Section: Discussionmentioning

confidence: 99%

“…It is recommended even when the pituitary adenoma is close to the optic apparatus if the dose to the optic apparatus is kept below 8 to 10 Gy. 37 If the tumor is close to the optic chiasm, fractionated SRS (usually 25 Gy in 5 fractions) may represent a better treatment option. Fractionated SRS would be the recommended radiation treatment modality for lesions > 3 cm in size and/or compressing the anterior visual pathway.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lymphocytic Hypophysitis Successfully Treated with Stereotactic Radiosurgery: Case Report and Review of the Literature

Pekić

Bogosavljević

Peker

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Lymphocytic hypophysitis (LH) is an autoimmune inflammatory infiltration of the pituitary gland, usually with a benign evolution. In rare circumstances the inflammatory process may extend beyond the pituitary and infiltrate the surrounding structures. We present a 42-year-old woman affected by an aggressive form of LH with extension to the cavernous sinus causing internal carotid artery occlusion and right sixth cranial nerve palsy. Prednisone therapy caused severe iatrogenic Cushing's syndrome, and the patient underwent transsphenoidal decompression. The histopathology report was consistent with LH. The patient was symptom free for a short period with reappearance of severe headache, diplopia, and hearing loss (middle ear inflammation) 3 months after surgery. Corticosteroids were reintroduced with the addition of azathioprine, but there was no regression of the pituitary mass. The patient was referred for stereotactic radiosurgery (SRS) using Gamma Knife (15 Gy to the margin). After 26 months, azathioprine was stopped, and the dose of prednisone was gradually tapered to 7.5 mg/day. Sellar magnetic resonance imaging showed regression of the pituitary mass. After follow-up for > 3 years after SRS, there was no clinical or radiologic evidence of the disease, but carotid arteries remained occluded. The patient developed secondary hypothyroidism and hypogonadism as consequences of SRS. An aggressive form of LH extending beyond the pituitary gland infiltrating surrounding structures is described. It was successfully treated with SRS after failure of transsphenoidal surgery and combined immunosuppressive therapy (prednisone, azathioprine). The review of the literature presents timely information concerning treatment with azathioprine and SRS of patients with an aggressive form of LH.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lymphocytic Hypophysitis Successfully Treated with Stereotactic Radiosurgery: Case Report and Review of the Literature

Pekić

Bogosavljević

Peker

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

show abstract

“…Unfortunately, endocrinological remission was not achieved 4 years after GKRS. The effect of SRS has been reported in the treatment of recurrent functioning PA 5,9) . Mouslech et al 12) reported a case of endocrinological remission of GKRS for recurrent TSH-PA.…”

Section: Discussionmentioning

confidence: 99%

Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

Byun

Kim

et al. 2020

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (PA) is an extremely rare functioning form of PA that accounts for 0.7-2% of all such cases. The previously reported outcomes of the surgical removal of TSH-PA are poor. Owing to its extremely low incidence, most available reports on TSH-PA are case reports or small case series. Thus, we investigated the clinical and endocrinological outcomes of surgically treated TSH-PA through our institutional series. Methods : We retrospectively reviewed 14 consecutive cases of surgically treated TSH-PA, focusing on the clinical, radiological, surgical, and endocrinological data. Results : There were seven male (50%) and seven female (50%) patients. The mean age was 42.5 years (range, 19-63). The mean tumor size was 16.6 mm (range, 4-30). Optic chiasm compression was noted in six patients (42.9%), and no patient showed cavernous sinus invasion. Thirteen of 14 patients (92.8%) underwent transnasal transsphenoidal approach (TSA), and one patient underwent TSA followed by transcranial approach for residual tumor removal. Thirteen of 14 patients (92.8%) showed endocrinological remission; all patients who experienced remission showed subnormal levels of TSH (<0.4 μU/mL) on postoperative day 2. Recurrence occurred in two patients (14.2%). One patient underwent subsequent revision transnasal TSA for recurrent tumor removal, and the other patient underwent gamma knife radiosurgery for recurrence. Conclusion : Surgical treatment showed excellent surgical outcomes. The TSH level in the immediate postoperative period may be a predictor for endocrinological remission. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

show abstract

“…For over one decade patients with pituitary adenoma have been treated primarily with two parallel opposed fields or a three field technique [1][2][3][4][5][6][7]. Only a few recent publications describe the application of intensity modulated radiotherapy (IMRT) or volumetric modulated arc (VMAT) technique in this region [8][9][10], none of them mentioning the flatness filter free (FFF) mode. FFF is applicable in combination with fluence modulating techniques like IMRT or VMAT.…”

Section: Introductionmentioning

confidence: 99%

The influence of radiotherapy techniques on the plan quality and on the risk of secondary tumors in patients with pituitary adenoma

Treutwein¹,

Steger²,

Loeschel

et al. 2020

BMC Cancer

View full text Add to dashboard Cite

Background: This planning study compares different radiotherapy techniques for patients with pituitary adenoma, including flatness filter free mode (FFF), concerning plan quality and secondary malignancies for potentially young patients. The flatness filter has been described as main source of photon scatter.Material and methods: Eleven patients with pituitary adenoma were included. An Elekta Synergy™ linac was used in the treatment planning system Oncentra® and for the measurements. 3D plans, IMRT, and VMAT plans and noncoplanar varieties were considered. The plan quality was evaluated regarding homogeneity, conformity, delivery time and dose to the organs at risk. The secondary malignancy risk was calculated from dose volume data and from measured dose to the periphery using different models for carcinoma and sarcoma risk.Results: The homogeneity and conformity were nearly unchanged with and without flattening filter, neither was the delivery time found substantively different. VMAT plans were more homogenous, conformal and faster in delivery than IMRT plans. The secondary cancer risk was reduced with FFF both in the treated region and in the periphery. VMAT plans resulted in a higher secondary brain cancer risk than IMRT plans, but the risk for secondary peripheral cancer was reduced. Secondary sarcoma risk plays a minor role. No advantage was found for non-coplanar techniques. The FFF delivery times were not shortened due to additional monitor units needed and technical limitations. The risk for secondary brain cancer seems to depend on the irradiated volume. Secondary sarcoma risk is much smaller than carcinoma risk in accordance to the results of the atomic bomb survivors. The reduction of the peripheral dose and resulting secondary malignancy risk for FFF is statistically significant. However, it is negligible in comparison to the risk in the treated region.Conclusion: Treatments with FFF can reduce secondary malignancy risk while retaining similar quality as with flattening filter and should be preferred. VMAT plans show the best plan quality combined with lowest peripheral secondary malignancy risk, but highest level of second brain cancer risk. Taking this into account VMAT FFF seems the most advantageous technique for the treatment of pituitary adenomas with the given equipment.

show abstract

Target delineation and optimal radiosurgical dose for pituitary tumors

Cited by 72 publications

References 143 publications

Lymphocytic Hypophysitis Successfully Treated with Stereotactic Radiosurgery: Case Report and Review of the Literature

Lymphocytic Hypophysitis Successfully Treated with Stereotactic Radiosurgery: Case Report and Review of the Literature

Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

The influence of radiotherapy techniques on the plan quality and on the risk of secondary tumors in patients with pituitary adenoma

Contact Info

Product

Resources

About