The Role of Radiation Therapy after Surgical Resection of Nonfunctional Pituitary Macroadenomas

Park, Paul; Chandler, William F.; Barkan, Ariel L.; Orrego, John J.; Cowan, John A.; Griffith, Kent A.; Tsien, Christina

doi:10.1227/01.neu.0000126885.71242.d7

Cited by 140 publications

(103 citation statements)

References 31 publications

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“…The most common complication after postoperative radiation therapy is pituitary hormone deficiency, whose reported rate ranges between 30% and 50% 15 . The risk of developing hormone insufficiency is persistent for up to more than 15 years after radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

et al. 2008

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BackgroundThe use of fractionated stereotactic radiotherapy (FSRT) has evolved with technical advances in noninvasive immobilization, radiation delivery, and image guidance. The application of FSRT to pituitary tumours is aimed at reducing toxicity through improved dose conformality and reduced treatment margins. The aim of the present paper is to report our own experience and to review the published data on FSRT for pituitary macroadenomas. MethodsBetween September 2000 and October 2005, 13 patients with pituitary macroadenoma underwent FSRT at our institution. In 12 patients, radiotherapy treatment followed surgical resection (transsphenoidal resection in 8, frontal craniotomy in 3, and multiple transsphenoidal resections followed by craniotomy in 1). In 4 patients, the tumours were functional (2 adrenocorticotropic hormone-secreting, 1 prolactinoma, and 1 growth hormone-secreting); the tumours in the remaining patients were clinically non-secretory. Before radiation, 3 patients had panhypopituitarism, and 6 patients had visual field defects. All patients were treated with FSRT using non-coplanar micro-multileaf collimation portals. A median dose of 50.4 Gy (range: 45-60 Gy) was prescribed to the 76.9%-95.2% isodose surface and delivered in 1.8-Gy fractions. The median planning target volume (gross tumour plus 3 mm) was 33.5 cm 3 (range: 3.2-75 cm 3 ). ResultsAfter a median follow-up of 24 months (range: 6-60 months), local control was 100%. One patient achieved clinical complete response. Treatment was well tolerated acutely for all patients. Neither radiation-induced optic neuropathy nor any radiation-related endocrine dysfunction was observed in our patients. ConclusionsIn accordance with published series, we found FSRT to be safe and effective in the management of large pituitary macroadenomas.

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Section: Discussionmentioning

confidence: 99%

“…CURRENT ONCOLOGY-VOLUME 15,NUMBER 6 such as the optic apparatus 3,5,6 . Here, we report our experience of FSRT in a series of 13 patients whose pituitary macroadenomas were in close relationship with the optic chiasm or the cavernous sinus, or both.…”

Section: Introductionmentioning

confidence: 99%

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

et al. 2008

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“…They constitute one‐third of all pituitary neoplasms2, 3 and have a prevalence of approximately 22 cases per 100 000 population 4. Postoperative radiotherapy (RT) is effective at reducing the risk of tumour regrowth after transsphenoidal surgery (TSS) 5, 6. However, patients with NFPA are at significant risk of hypopituitarism, which may be secondary to the tumour itself or a sequela of its treatment.…”

Section: Introductionmentioning

confidence: 99%

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

O’Reilly

Reulen

Gupta

et al. 2016

Clinical Endocrinology

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SummaryContext and ObjectiveNonfunctioning pituitary adenomas (NFPAs) are the most common subtype of pituitary tumour. Hypopituitarism is observed in NFPAs due to tumour‐ or treatment‐related factors and may increase mortality risk. Here, we analysed the associations of hypopituitarism, hormone replacement and mortality in a large NFPA cohort derived from two large European centres.Design, Setting and ParticipantsCase note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1999 and 2014 was performed.Main Outcome MeasuresClinical presentation, treatment strategies, pituitary function and vitality status were recorded in each patient. A multivariate Cox regression model was used to examine the association between hypopituitarism, hormone replacement and premature mortality.ResultsA total of 519 patients were included in the analysis. Median duration of follow‐up was 7·0 years (0·5–43). A total of 81 deaths were recorded (15·6%). On multivariate analysis, adrenocorticotropic hormone (ACTH) and gonadotropin (Gn) deficiencies were associated with an increased relative risk of death (OR 2·26, 95% CI 1·15–4·47, P = 0·01 and OR 2·56, 95% CI 1·10–5·96, P = 0·01, respectively). Increased hydrocortisone (HC) (P‐trend = 0·02) and lower levothyroxine (LT4) doses (P‐trend = 0·03) were associated with increased risk of death. Mortality increased with the degree of pituitary failure observed (P‐trend = 0·04).ConclusionACTH and gonadotropin‐deficient patients have higher mortality rates compared to those with intact hormonal axes. Excessive HC and suboptimal LT4 replacement may also increase risk of death. Complex associations between hormone deficiency and replacement underpin the increased mortality risk in NFPA patients.

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“…Some studies report, to a variable degree, an improvement in pituitary function (4,(7)(8)(9)(10)(11), whereas others could not demonstrate significant improvement in pituitary function, or even showed decreased pituitary function after transsphenoidal surgery (5,12,13). Transsphenoidal surgery leads to long-term tumor control in approximately 80% of patients (3,(14)(15)(16), and, in selected series, in even more than 90% of the patients (15,17).…”

Section: Introductionmentioning

confidence: 99%

The natural course of non-functioning pituitary macroadenomas

Dekkers¹,

Hammer²,

Keizer³

et al. 2007

eur j endocrinol

166

129

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Objective: The natural history of non-functioning pituitary macroadenomas (NFMA) has not been completely elucidated. Therefore, we evaluated pituitary function, visual fields, and tumor size during long-term follow-up of non-operated patients with NFMA. Design: Follow-up study. Patients: Twenty-eight patients (age 55G3 years) with NFMA, not operated after initial diagnosis, were included. Results: Initial presentation was pituitary insufficiency in 44%, visual field defects in 14%, apoplexy in 14%, and chronic headache in 7% of the patients. The duration of follow-up was 85G13 months. Radiological evidence of tumor growth was observed in 14 out of 28 patients (50%) after duration of follow-up of 118G24 months. Six patients (21%) were operated, because tumor growth was accompanied by visual field defects. Visual impairments improved in all the cases after transsphenoidal surgery. Spontaneous reduction in tumor volume was observed in eight patients (29%). No independent predictors for increase or decrease in tumor volume could be found by regression analysis. Conclusion: Observation alone is a safe alternative for transsphenoidal surgery in selected NFMA patients, without the risk of irreversibly compromising visual function. European Journal of Endocrinology 156 217-224

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The Role of Radiation Therapy after Surgical Resection of Nonfunctional Pituitary Macroadenomas

Cited by 140 publications

References 31 publications

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

The natural course of non-functioning pituitary macroadenomas

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