Radiosurgical treatment of residual and recurrent pituitary adenomas
Objective ‒ the treatment result estimation of subtotally removed and recurrent pituitary adenomas using different algorithms of radiotherapy and radiosurgery.
Materials and methods. The retrospective analysis of 21 cases of pituitary adenomas was performed. There were 11 women and 10 men included. The average age was 45 (from 18 to 72) years. All patients had relapse or residual tumor after incomplete surgical removal. The method of irradiation was chosen by a radiologist. Tumor size control was assessed by an independent radiologist in 3 months and 1 year after treatment. Endocrine function was estimated by an independent endocrinologist in 3 months and 1 year after treatment.
Results. Following transsphenoidal removal ‒ 13 patients (4 were operated twice), 5 after cranial surgery and 3 were operated sequentially transnasally and transcranially. Irradiation of 14 cases of residual tumor was performed no later than 6 months after surgery. The mean term of treatment start of recurrent adenomas was 12 months (8‒17) after surgery. VARIAN Novalis was applied in 16 cases, VARIAN Clinac iX in 4 cases and VARIAN TrueBeam STx was used once. Single and total radiation doses were determined individually. None of patients had visual impairment after treatment. The hypopituitarism deterioration was not noted as well.
Conclusions. Hypofractionated stereotactic radiosurgery allows to bring a high dose of radiation to the pituitary adenomas, minimizing damage to the visual pathways, the pituitary gland and infundibulum. As the sequence, it reduces the toxicity of the technique. The application of modern radiation technologies minimize the irradiation of healthy surrounding tissues and reduce the negative effects of treatment.
Alonso CE, Bunevicius A, Trifiletti DM et al. Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study. J Neurooncol. 2019 Nov;145(2):301-7. doi: 10.1007/s11060-019-03296-8. Epub 2019 Sep 20. PMID: 31541405.
Puataweepong P, Dhanachai M, Hansasuta A et al. The clinical outcome of hypofractionated stereotactic radiotherapy with cyberknife robotic radiosurgery for perioptic pituitary adenoma. Technol Cancer Res Treat. 2016 Dec;15(6):NP10-NP15. doi: 10.1177/1533034615607113. Epub 2015 Sep 30. PMID: 26424501.
Colin P, Jovenin N, Delemer B et al. Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: a prospective study of 110 patients. Int J Radiat Oncol Biol Phys. 2005 Jun 1;62(2):333-41. doi: 10.1016/j.ijrobp.2004.09.058. PMID: 15890572.
Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML. Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg. 2011 Feb;114(2):303-9. doi: 10.3171/2010.5.JNS091635. Epub 2010 Jun 11. PMID: 20540596.
Chanson P, Dormoy A, Dekkers OM. Use of radiothe-rapy after pituitary surgery for non-functioning pituitary adenomas. Eur J Endocrinol. 2019 Jul;181(1):D1-D13. doi: 10.1530/EJE-19-0058. PMID: 31048560.
Ramos-Prudencio R, Pérez-Álvarez SI, Flores-Balcazar CH et al. Radiotherapy for the treatment of pituitary adenomas: A dosimetric comparison of three planning techniques. Rep Pract Oncol Radiother. 2020 Jul-Aug;25(4):586-93. doi: 10.1016/j.rpor.2020.04.020. Epub 2020 May 19. PMID: 32508534; PMCID: PMC7264003.
Minniti G, Flickinger J, Tolu B, Paolini S. Management of nonfunctioning pituitary tumors: radiotherapy. Pituitary. 2018 Apr;21(2):154-61. doi: 10.1007/s11102-018-0868-4. PMID: 29372392.
Sherry AD, Khattab MH, Xu MC et al. Outcomes of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for refractory Cushing’s di-sease. Pituitary. 2019 Dec;22(6):607-13. doi: 10.1007/s11102-019-00992-6. PMID: 31552580.
Jagannathan J, Sheehan JP, Pouratian N et al. Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery. 2008 Jun;62(6):1262-9; discussion 1269-70. doi: 10.1227/01.neu.0000333297.41813.3d. PMID: 18824992.
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 Jun;98(2):185-94. doi: 10.1007/s11060-010-0172-2. Epub 2010 Apr 22. PMID: 20411299.
Liao HI, Wang CC, Wei KC et al. Fractionated stereotactic radiosurgery using the Novalis system for the management of pituitary adenomas close to the optic apparatus. J Clin Neurosci. 2014 Jan;21(1):111-5. doi: 10.1016/j.jocn.2013.03.024. Epub 2013 Sep 29. PMID: 24084193.
Zhang L, Chen W, Ding C et al. Gamma Knife radiosurgery as the initial treatment for elderly patients with nonfunctioning pituitary adenomas. J Neurooncol. 2021 Apr;152(2):257-64. doi: 10.1007/s11060-021-03724-8. Epub 2021 Feb 27. PMID: 33638114.
Hasegawa T, Shintai K, Kato T, Iizuka H. Stereotactic radiosurgery as the initial treatment for patients with nonfunctioning pituitary adenomas. World Neurosurg. 2015 Jun;83(6):1173-9. doi: 10.1016/j.wneu.2015.01.054. Epub 2015 Feb 17. PMID: 25700971.
Kotecha R, Sahgal A, Rubens M et al. Stereotactic radiosurgery for non-functioning pituitary adenomas: meta-analysis and International Stereotactic Radiosurgery Society practice opinion. Neuro Oncol. 2020 Mar 5;22(3):318-32. doi: 10.1093/neuonc/noz225. PMID: 31790121; PMCID: PMC7058447.
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