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J Neurol Surg B Skull Base 2015; 76(05): 351-357
DOI: 10.1055/s-0035-1549309
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical and Radiologic Outcome of Gamma Knife Radiosurgery on Nonfunctioning Pituitary Adenomas

Shyamal C. Bir
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Richard D. Murray
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Sudheer Ambekar
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Papireddy Bollam
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Anil Nanda
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
› Author Affiliations
Further Information

Publication History

28 October 2014

12 February 2015

Publication Date:
08 May 2015 (online)

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Abstract

Objective To elucidate the role of Gamma Knife radiosurgery (GKRS) in the management of nonfunctioning pituitary adenomas (NFAs).

Materials and Methods A retrospective review of 57 consecutive patients spanning 2000 to 2013 with NFAs was performed. Of 57 patients, 53 patients had recurrent or residual tumors after microsurgical resection. The study population was evaluated clinically and radiographically after GKRS treatment. The median follow-up time was 45.57 months.

Results GKRS in pituitary adenomas showed significant variations in tumor growth control (decreased in 32 patients [56.1%], arrested growth in 21 patients [36.1%], and increased tumor size in 4 patients [7%]). Progression-free survival after GKRS at 3, 7, and 10 years was 100%, 98%, and 90%, respectively. The neurologic signs and symptoms were significantly improved after GKRS (14% versus 107%) compared with pretreated signs and symptoms (p < 0.0001). Five patients (8.8%) required additional treatment.

Conclusion Recent follow-up revealed that GKRS offers a high rate of tumor control and preservation of neurologic functions in both new and recurrent patients with NFAs. Thus GKRS is an effective treatment option for recurrent and residual as well as newly diagnosed patients with NFAs.

Keywords

nonfunctioning pituitary adenomas - Gamma Knife surgery - clinical and radiologic outcome
 

  • References

  • 1 Lee CC, Kano H, Yang HC , et al. Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas. J Neurosurg 2014; 120 (3) 647-654
    CrossrefPubMedGoogle Scholar
  • 2 Laws Jr ER, Vance ML. Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am 1999; 10 (2) 327-336
    CrossrefPubMedGoogle Scholar
  • 3 Sheehan JP, Starke RM, Mathieu D , et al. Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 2013; 119 (2) 446-456
    CrossrefPubMedGoogle Scholar
  • 4 Rim CH, Yang DS, Park YJ, Yoon WS, Lee JA, Kim CY. Radiotherapy for pituitary adenomas: long-term outcome and complications. Radiat Oncol J 2011; 29 (3) 156-163
    CrossrefPubMedGoogle Scholar
  • 5 Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA. Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation—a follow-up study. Clin Endocrinol (Oxf) 1999; 51 (3) 281-284
    CrossrefPubMedGoogle Scholar
  • 6 Chang EF, Sughrue ME, Zada G, Wilson CB, Blevins Jr LS, Kunwar S. Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 2010; 13 (3) 223-229
    CrossrefPubMedGoogle Scholar
  • 7 Gittoes NJ, Bates AS, Tse W , et al. Radiotherapy for non-function pituitary tumours. Clin Endocrinol (Oxf) 1998; 48 (3) 331-337
    CrossrefPubMedGoogle Scholar
  • 8 Marcou Y, Plowman PN. Stereotactic radiosurgery for pituitary adenomas. Trends Endocrinol Metab 2000; 11 (4) 132-137
    CrossrefPubMedGoogle Scholar
  • 9 Laws Jr ER, Fode NC, Redmond MJ. Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients. J Neurosurg 1985; 63 (6) 823-829
    CrossrefPubMedGoogle Scholar
  • 10 Park KJ, Kano H, Parry PV , et al. Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery 2011; 69 (6) 1188-1199
    CrossrefPubMedGoogle Scholar
  • 11 Hayashi M, Chernov M, Tamura N , et al. Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol 2010; 98 (2) 185-194
    CrossrefPubMedGoogle Scholar
  • 12 Pollock BE, Cochran J, Natt N , et al. Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys 2008; 70 (5) 1325-1329
    CrossrefPubMedGoogle Scholar
  • 13 Sheehan JP, Niranjan A, Sheehan JM , et al. Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg 2005; 102 (4) 678-691
    CrossrefPubMedGoogle Scholar
  • 14 Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 2005; 56 (6) 1222-1233 ; discussion 1233
    CrossrefPubMedGoogle Scholar
  • 15 Kurosaki M, Lüdecke DK, Flitsch J, Saeger W. Surgical treatment of clinically nonsecreting pituitary adenomas in elderly patients. Neurosurgery 2000; 47 (4) 843-848 ; discussion 848–849
    CrossrefPubMedGoogle Scholar
  • 16 Yang SY, Zhu T, Zhang JN, Sun YS. Transsphenoidal microsurgical management of pituitary adenomas. Microsurgery 1994; 15 (11) 754-759
    CrossrefPubMedGoogle Scholar
  • 17 Ciric I, Mikhael M, Stafford T, Lawson L, Garces R. Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 1983; 59 (3) 395-401
    CrossrefPubMedGoogle Scholar
  • 18 Brada M, Jankowska P. Radiotherapy for pituitary adenomas. Endocrinol Metab Clin North Am 2008; 37 (1) 263-275 , xi
    CrossrefPubMedGoogle Scholar
  • 19 McCord MW, Buatti JM, Fennell EM , et al. Radiotherapy for pituitary adenoma: long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 1997; 39 (2) 437-444
    CrossrefPubMedGoogle Scholar
  • 20 Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 1989; 70 (262) 145-160
    PubMedGoogle Scholar
  • 21 Minniti G, Traish D, Ashley S, Gonsalves A, Brada M. Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 2005; 90 (2) 800-804
    CrossrefPubMedGoogle Scholar
  • 22 Pollock BE, Carpenter PC. Stereotactic radiosurgery as an alternative to fractionated radiotherapy for patients with recurrent or residual nonfunctioning pituitary adenomas. Neurosurgery 2003; 53 (5) 1086-1091 ; discussion 1091–1094
    CrossrefPubMedGoogle Scholar
  • 23 Mingione V, Yen CP, Vance ML , et al. Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 2006; 104 (6) 876-883
    CrossrefPubMedGoogle Scholar
  • 24 Lim YL, Leem W, Kim TS, Rhee BA, Kim GK. Four years' experiences in the treatment of pituitary adenomas with gamma knife radiosurgery. Stereotact Funct Neurosurg 1998; 70 (Suppl. 01) 95-109
    CrossrefPubMedGoogle Scholar
  • 25 Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD. Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 2002; 97 (5, Suppl): 408-414
    CrossrefPubMedGoogle Scholar
  • 26 Leber KA, Berglöff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998; 88 (1) 43-50
    CrossrefPubMedGoogle Scholar
  • 27 Ove R, Kelman S, Amin PP, Chin LS. Preservation of visual fields after peri-sellar gamma-knife radiosurgery. Int J Cancer 2000; 90 (6) 343-350
    CrossrefPubMedGoogle Scholar
  • 28 Duma CM, Lunsford LD, Kondziolka D, Harsh IV GR, Flickinger JC. Stereotactic radiosurgery of cavernous sinus meningiomas as an addition or alternative to microsurgery. Neurosurgery 1993; 32 (5) 699-704 ; discussion 704–705
    CrossrefPubMedGoogle Scholar
  • 29 El-Shehaby AM, Reda WA, Tawadros SR, Abdel Karim KM. Low-dose Gamma Knife surgery for nonfunctioning pituitary adenomas. J Neurosurg 2012; 117 (Suppl): 84-88
    PubMedGoogle Scholar
  • 30 Liscák R, Vladyka V, Marek J, Simonová G, Vymazal J. Gamma knife radiosurgery for endocrine-inactive pituitary adenomas. Acta Neurochir (Wien) 2007; 149 (10) 999-1006 ; discussion 1006
    CrossrefPubMedGoogle Scholar
  • 31 Iwai Y, Yamanaka K, Yoshioka K. Radiosurgery for nonfunctioning pituitary adenomas. Neurosurgery 2005; 56 (4) 699-705 ; discussion 699–705
    CrossrefPubMedGoogle Scholar
  • 32 Stafford SL, Pollock BE, Leavitt JA , et al. A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2003; 55 (5) 1177-1181
    CrossrefPubMedGoogle Scholar
  • 33 Leber KA, Berglöff J, Langmann G, Mokry M, Schröttner O, Pendl G. Radiation sensitivity of visual and oculomotor pathways. Stereotact Funct Neurosurg 1995; 64 (Suppl. 01) 233-238
    PubMedGoogle Scholar
  • 34 Kuo JS, Chen JC, Yu C , et al. Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 2004; 54 (6) 1385-1393 ; discussion 1393–1394
    CrossrefPubMedGoogle Scholar
  • 35 Abe T, Yamamoto M, Taniyama M, Tanioka D, Izumiyama H, Matsumoto K. Early palliation of oculomotor nerve palsy following gamma knife radiosurgery for pituitary adenoma. Eur Neurol 2002; 47 (1) 61-63
    CrossrefPubMedGoogle Scholar
  • 36 Yoon SC, Suh TS, Jang HS , et al. Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1998; 41 (4) 849-853
    CrossrefPubMedGoogle Scholar
  • 37 Vladyka V, Liscák R, Novotný Jr J, Marek J, Jezková J. Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 2003; 52 (2) 309-316 ; discussion 316–317
    CrossrefPubMedGoogle Scholar
  • 38 Xu Z, Lee Vance M, Schlesinger D, Sheehan JP. Hypopituitarism after stereotactic radiosurgery for pituitary adenomas. Neurosurgery 2013; 72 (4) 630-637 , 636–637
    CrossrefPubMedGoogle Scholar