Abstract
Simple SummaryPituitary tumors represent approximately 10–15% of all brain neoplasms. Gamma Knife, the most commonly used stereotactic radiosurgery technique worldwide, plays an important role in the treatment of several pituitary neoplasm. It is currently used in cases of residual or recurrent tumors after surgery or as primary treatment when surgery is contraindicated. Its goals are long-term tumor control, preservation of visual function, and, for secreting pituitary adenomas, endocrine remission. Several retrospective case-series (level of evidence IV) on Gamma Knife for pituitary tumors have been published describing encouraging outcomes; only one systematic review and meta-analysis on non-functioning pituitary adenoma has been recently reported. We provide a systematic review of the literature and meta-analysis from the last two decades on Gamma Knife radiosurgery for several pituitary tumors with the aim of describing and confirming safety and effectiveness of this technique.To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89–97%) and 95% (95% CI 91–99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35–54%) for GH-secreting adenomas, 64% (95% CI 0.52–0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19–48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67–81%) and 70% (95% CI: 64–76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.
Highlights
Pituitary gland tumors represent approximately 10–15% of all brain neoplasms
Some tumors are detected as incidental findings on magnetic resonance imaging (MRI) or computed tomography (CT) scans performed for some other reasons [1,3]
In this systematic review of the literature and meta-analysis, we mainly focus on Gamma Knife radiosurgery (GK) in the treatment of non-functioning pituitary adenoma (NFPA, namely null cell adenoma), secreting pituitary adenomas, neurohypophyseal tumors, pituitary carcinomas, and craniopharyngiomas
Summary
Pituitary gland tumors represent approximately 10–15% of all brain neoplasms. Most of them are pituitary adenomas (up to 80–90%), but they include other lesions of different histological nature, both benign and malignant [1,2]. Pituitary neoplasms often are detected because of signs and symptoms related to over- or under-secretion of pituitary gland hormones; others are found because of local compression of nearby structures such as the optic chiasm. Treatment options of pituitary tumors include surgery, radiosurgery, radiation therapy, and in the case of hormonally active tumors, medical suppression treatment [1,3,4,5]. For patients with tumors compressing the optic system or those that are hormonally active, therapeutic goals are histological diagnosis, radical removal of the intrasellar lesion to avoid recurrence and relief of any visual impairment or other neurologic symptoms and management of hormonal hypersecretions/deficiencies. Surgery is the first line option for most pituitary tumors except prolactinomas [3,4]; for those tumors found incidentally, surgery is generally indicated for “incidentalomas“ of 1 cm or more in diameter, or when tumor enlargement is detected in patients during serial neuroradiological follow-up [3]
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