The authors report on a retrospective analysis of the imaging and clinical outcomes following gamma surgery in 100 patients with nonsecretory pituitary macroadenoma.
Between June 1989 and March 2004, 100 consecutive patients with nonsecretory pituitary macroadenoma were treated at the Lars Leksell Center for Gamma Surgery, University of Virginia Health System (Charlottesville, VA). Ninety-two patients had residual or recurrent macroadenoma following one or more surgical procedures. In eight patients, gamma surgery was the primary treatment. Ten patients received conventional fractionated radiotherapy before the gamma surgery. Sixty-nine patients required hormone replacement therapy for one or more deficits before gamma knife treatment. Peripheral doses between 5 and 25 Gy (mean 18.5 Gy) were administered.
Imaging and endocrinological follow-up evaluations were performed in 90 patients; these studies ranged from 6 to 142 months (mean 44.9 months) and 6 to 127 months (mean 47.9 months), respectively. Tumor volume decreased in 59 patients (65.6%), remained unchanged in 24 (26.7%), and increased in seven (7.8%). The minimal effective peripheral dose was 12 Gy; peripheral doses greater than 20 Gy did not seem to provide additional benefit. Of 61 patients with a partially or fully functioning pituitary gland and follow-up data, 12 (19.7%) suffered new hormone deficits following gamma surgery. In patients with endocrinological follow-up data that had been collected over more than 2 years, the rate of new deficits was 25%. No neurological morbidity or death was related to treatment.
Current experience suggests that gamma surgery is an appropriate means of managing recurrent or residual nonsecretory pituitary macroadenoma following microsurgery and a primary treatment in selected patients. To evaluate definite rates of recurrence and new endocrine deficiencies, long-term follow-up studies are needed.
Al-MeftyO,,KershJE,,RouthA,&SmithRR:The long-term side effects of radiation therapy for benign brain tumors in adults.J Neurosurg73:502- - - - - -512,1990
Al-MeftyO,&SmithRR:Surgery of tumors invading the cavernous sinus.Surg Neurol30:370- - - - - -381,1988
BenvenisteRJ,,KingWA,,WalshJ,,LeeJS,,DelmanBN,&PostKD:Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma.J Neurosurg102:1004- - - - - -1012,2005
BoelaertK,&GittoesNJ:Radiotherapy for non-functioning pituitary adenomas.Eur J Endocrinol144:569- - - - - -575,2001
BradaM,,FordD,,阿什利S,,BlissJM,,CrowleyS,&MasonM,et al.:Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma.BMJ304:1343- - - - - -1346,1992
BradaM,,RajanB,,TraishD,,阿什利S,,Holmes-SellorsPJ,&NusseyS,et al.:The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas.Clin Endocrinol (Oxf)38:571- - - - - -578,1993
BreenP,,FlickingerJC,,KondziolkaD,&MartinezAJ:Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control.J Neurosurg89:933- - - - - -938,1998
CiricI,,MikhaelM,,StaffordT,,法律onL,&GarcesR:Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results.J Neurosurg59:395- - - - - -401,1983
ComtoisR,,BeauregardH,,SommaM,,SerriO,,Aris-JilwanN,&HardyJ:The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas.Cancer68:860- - - - - -866,1991
DolencVV:Transcranial epidural approach to pituitary tumors extending beyond the sella.开云体育app官方网站下载入口41:542- - - - - -552,1997
EbersoldMJ,,QuastLM,,法律ERJr,,ScheithauerB,&RandallRV:Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas.J Neurosurg64:713- - - - - -719,1986
FlickingerJC,,NelsonPB,,MartinezAJ,,DeutschM,&TaylorF:Radiotherapy of nonfunctional adenomas of the pituitary gland. Results with long-term follow-up.Cancer63:2409- - - - - -2414,1989
GanzJC,,BacklundEO,&ThorsenFA:The effects of Gamma Knife surgery of pituitary adenomas on tumor growth and endocrinopathies.Stereotact Funct Neurosurg61:Suppl 130- - - - - -37,1993
GirkinCA,,ComeyCH,,LunsfordLD,,GoodmanML,&KlineLB:Radiation optic neuropathy after stereotactic radiosurgery.Ophthalmology104:1634- - - - - -1643,1997
GittoesNJ,,BatesAS,,TseW,,BullivantB,,SheppardMC,&ClaytonRN,et al.:Radiotherapy for non-function pituitary tumors.Clin Endocrinol (Oxf)48:331- - - - - -337,1998
GuyJ,,MancusoA,,BeckR,,MosterML,,SedwickLA,&QuislingRG,et al.:Radiation-induced optic neuropathy: a magnetic resonance imaging study.J Neurosurg74:426- - - - - -432,1991
HakubaA,,TanakaK,,铃木T,&NishimuraS:A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus.J Neurosurg71:699- - - - - -704,1989
HayashiM,,IzawaM,,HiyamaH,,NakamuraS,,AtsuchiS,&SatoH,et al.:Gamma Knife radiosurgery for pituitary adenomas.Stereotact Funct Neurosurg72:Suppl 1111- - - - - -118,1999
HoybyeC,,GrenbackE,,RahnT,,DegerbladM,,ThorenM,&HultingAL:Adrenocorticotropic hormone-producing pituitary tumors: 12 to 22-year follow-up after treatment with stereotactic radiosurgery.开云体育app官方网站下载入口49:284- - - - - -292,2001
InoueHK,,KohgaH,,HiratoM,,SasakiT,,IshiharaJ,&ShibazakiT,et al.:Pituitary adenomas treated by microsurgery with or without Gamma Knife surgery: experience in 122 cases.Stereotact Funct Neurosurg72:Suppl 1125- - - - - -131,1999
KalapurakalJA,,SilvermanCL,,AkhtarN,,DownesB,,AndrewsDW,&LaskeDW,et al.:Acute hyperthermia following stereotactic radiosurgery for pituitary adenoma.Br J Radiol72:1218- - - - - -1221,1999
KovacsK,,ScheithauerBW,,HorvathE,&LloydRV:The World Health Organization classification of adenohypophysial neoplasms. A proposed five-tier scheme.Cancer78:502- - - - - -510,1996
LandoltAM,,HallerD,,LomaxN,,ScheibS,,SchubigerO,&SiegfriedJ,et al.:Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy.J Neurosurg88:1002- - - - - -1008,1998
法律ERJr,,FodeNC,&RedmondMJ:Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients.J Neurosurg63:823- - - - - -829,1985
法律ERJr,&ThaparK:Pituitary surgery.Endocrinol Metab Clin North Am28:119- - - - - -131,1999
LilleheiKO,,KirschmanDL,,Kleinschmidt-DeMastersBK,&Ridg-wayEC:Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas.开云体育app官方网站下载入口43:432- - - - - -439,1998
LimYJ,,LeemW,,ParkJT,,KimTS,,RheeBA,&KimGK:Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: a case report.Stereotact Funct Neurosurg72:Suppl 1132- - - - - -139,1999
LimYL,,LeemW,,KimTS,,RheeBA,&KimGK:Four years’ experiences in the treatment of pituitary adenomas with gamma knife radiosurgery.Stereotact Funct Neurosurg70:Suppl 195- - - - - -109,1998
LoefflerJS,,NiemierkoA,&ChapmanPH:Second tumors after radiosurgery: tip of the iceberg or a bump in the road?.开云体育app官方网站下载入口52:1436- - - - - -1442,2003
LosaM,,ValleM,,MortiniP,,FranzinA,,da PassanoCF,&CenzatoM,et al.:Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking.J Neurosurg100:438- - - - - -444,2004
LudeckeDK,,FlitschJ,,KnappeUJ,&SaegerW:Cushing’s disease: a surgical view.J Neurooncol54:151- - - - - -166,2001
MartinezR,,BravoG,,BurzacoJ,&ReyG:Pituitary tumors and gamma knife surgery. Clinical experience with more than two years of follow-up.Stereotact Funct Neurosurg70:Suppl 1110- - - - - -118,1998
MatsunoA,,SasakiT,,SaitoN,,MochizukiT,,FujimakiT,&KirinoT,et al.:Transcavernous surgery; an effective treatment for pituitary macroadenomas.Eur J Endocrinol133:156- - - - - -165,1995
McColloughWM,,MarcusRBJr,,RhotonALJr,,博林格WE,&MillionRR:Long-term follow-up of radiotherapy for pituitary adenoma: the absence of late recurrence after greater than or equal to 4500 cGy.Int J Radiat Oncol Biol Phys21:607- - - - - -614,1991
McCordMW,,BuattiJM,,FennellEM,,MendenhallWM,,MarcusRBJr,&RhotonAL,et al.:Radiotherapy for pituitary adenoma: long-term outcome and sequelae.Int J Radiat Oncol Biol Phys39:437- - - - - -444,1997
MitsumoriM,,ShrieveDC,,AlexanderEIII,,KaiserUB,,RichardsonGE,&BlackPM,et al.:Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas.Int J Radiat Oncol Biol Phys42:573- - - - - -580,1998
MokryM,,Ramschak-SchwarzerS,,SimbrunnerJ,,GanzJC,&PendlG:A six year experience with the postoperative radiosurgical management of pituitary adenomas.Stereotact Funct Neurosurg72:Suppl 188- - - - - -100,1999
Morange-RamosI,,RegisJ,,DufourH,,AndrieuJM,,GrisoliF,&JaquetP,et al.:Gamma-knife surgery for secreting pituitary adenomas.Acta Neurochir (Wien)140:437- - - - - -443,1998
OveR,,KelmanS,,AminPP,&ChinLS:Preservation of visual fields after perisellar gamma-knife radiosurgery.Int J Cancer90:343- - - - - -350,2000
PanL,,ZhangN,,WangE,,WangB,&XuW:Pituitary adenomas: the effect of gamma knife radiosurgery on tumor growth and endocrinopathies.Stereotact Funct Neurosurg70:Suppl 1119- - - - - -126,1998
PlowmanPN,&DoughtyD:Stereotactic radiosurgery, X: clinical isodosimetry of gamma knife versus linear accelerator X-knife for pituitary and acoustic tumors.Clin Oncol (R Coll Radiol)11:321- - - - - -329,1999
PollockBE,,KondziolkaD,,LunsfordLD,&FlickingerJC:Stereo-tactic radiosurgery for pituitary adenomas: imaging, visual and endocrine results.Acta Neurochir Suppl62:33- - - - - -38,1994
RocherFP,,SentenacI,,BergerC,,MarquisI,,RomestaingP,&GerardJP:Stereotactic radiosurgery: the Lyon experience.Acta Neurochir Suppl63:109- - - - - -114,1995
RushS,&CooperPR:Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macro-adenomas.Int J Radiat Oncol Biol Phys37:1031- - - - - -1034,1997
SepehrniaA,,SamiiM,&TatagibaM:Management of intracavernous tumors: an 11-year experience.Acta Neurochir Suppl53:122- - - - - -126,1991
希恩JP,,KondziolkaD,,FlickingerJ,&LunsfordLD:Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.J Neurosurg97:5 Suppl408- - - - - -414,2002
SnyderPJ,,FowbleBF,,SchatzNJ,,SavinoPJ,&GennarelliTA:Hypopituitarism following radiation therapy of pituitary adenomas.Am J Med81:457- - - - - -462,1986
StaffordSL,,PollockBE,,LeavittJA,,FooteRL,,BrownPD,&LinkMJ,et al.:A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery.Int J Radiat Oncol Biol Phys55:1177- - - - - -1181,2003
StephanianE,,LunsfordLD,,CoffeyRJ,,BissonetteDJ,&FlickingerJC:Gamma knife surgery for sellar and suprasellar tumors.Neurosurg Clin N Am3:207- - - - - -218,1992
ThorenM,,RahnT,,GuoWY,&WernerS:Stereotactic radiosurgery with the cobalt-60 gamma unit in the treatment of growth hormone-producing pituitary tumors.开云体育app官方网站下载入口29:663- - - - - -668,1991
TishlerRB,,LoefflerJS,,LunsfordLD,,DumaC,,AlexanderEIII,&KooyHM,et al.:Tolerance of cranial nerves of the cavernous sinus to radiosurgery.Int J Radiat Oncol Biol Phys27:215- - - - - -221,1993
TsangRW,,BrierleyJD,,PanzarellaT,,GospodarowiczMK,,SutcliffeSB,&SimpsonWJ:Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors.Int J Radiat Oncol Biol Phys30:557- - - - - -565,1994
WebbKM,,LaurentJJ,,OkonkwoDO,,LopesMB,,VanceML,&法律ERJr:Clinical characteristics of silent corticotrophic adenomas and creation of an internet-accessible database to facilitate their multi-institutional study.开云体育app官方网站下载入口53:1076- - - - - -1085,2003
WowraB,&StummerW:Efficacy of gamma knife radiosurgery for nonfunctioning pituitary adenomas: a quantitative follow up with magnetic resonance imaging-based volumetric analysis.J Neurosurg97:5 Suppl429- - - - - -432,2002
ZierhutD,,FlentjeM,,AdolphJ,,ErdmannJ,,RaueF,&Wannen-macherM:External radiotherapy of pituitary adenomas.Int J Radiat Oncol Biol Phys33:307- - - - - -314,1995
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