Abstract
ObjectTo assess the effects of radiosurgery (RS) on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas.MethodsRetrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels) and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS.ResultsThe median follow-up was 42 months (6-109 months). The median dose was 12,5 Gy (9 - 15 Gy) and 20 Gy (12 - 28 Gy) for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42) of the cases and tumor shrinkage ocurred in 10% (4 in 42) of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS.ConclusionsRS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly acceptable radiological and hormonal control and absence of complications at this early follow-up are consistent with literature.
Highlights
Pituitary adenomas represent nearly 15% of all intracranial tumors and are associated with significant morbidity due to either local compressive effects and/or hormonal hypersecretion [1]
2 patients were treated with surgery followed by external beam radiotherapy (EBRT)
There were no relationships between median dose or tumoral volume and hormonal control (HC) or hormonal normalization (HN)
Summary
Pituitary adenomas represent nearly 15% of all intracranial tumors and are associated with significant morbidity due to either local compressive effects and/or hormonal hypersecretion [1]. Their clinical classification into nonfunctioning or functioning tumors is defined on the basis of hormonal serum level. Transsphenoidal microsurgery has remained the primary treatment for most patients with non-functioning pituitary microadenomas or functioning microadenomas causing acromegaly or Cushing’s. The persistence or recurrence of disease due to tumor invasion into surrounding structures or incomplete tumor resection is quite common and long term tumor control rates after transsphenoidal excision alone vary from 50 to 80% [4]. For residual or recurrent tumors fractionated radiation therapy has been the traditional treatment. It has a prolonged latency up to one decade for its effects and is associated with more frequent side effects as hypopituitarism, visual damage and cerebral vasculopathy [2,5]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call