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20.05.2022 | Research

Long-term hormonal and imaging outcomes of adjunctive gamma knife radiosurgery in non-functioning pituitary adenomas: a single center experience

verfasst von: Aasim N. Maldar, Sanjeev Pattankar, Basant K. Misra, Phulrenu H. Chauhan, Milind Sankhe, Ketan Desai, N. F. Shah

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2022

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Abstract

Purpose

Gamma Knife Radiosurgery(GKRS) is an established modality for treatment of non-functioning pituitary adenomas(NFPA). The objective of the study was to assess long-term hormonal and imaging outcomes after adjunctive GKRS in patients with NFPA.

Methods

A retrospective review of records of 109 patients with NFPA, from 1996 to 2020, who received adjunctive GKRS, was performed. Patients who had received GKRS as the primary modality of treatment for NFPA were not included.

Results

Sixty-three (57.8%) patients were available for follow up at our institute. The median follow-up period was 47 months (range, 6–260). At a median time of 38 months (range, 8–97), 25 (39.7%) patients developed ≥ 1 new pituitary hormone deficiency. Median time to cortisol deficiency was 38 months (range, 8–55), thyroid hormone deficiency was 45.5 months (range, 12–97) and gonadotropin deficiency was 45 months (range, 21–75). The actuarial risk of developing a new pituitary hormone deficit at 1, 3, 5, 7, and 10 years was 2.5%, 11%, 26.3%, 28% and 29.7%, respectively. Adenoma size decreased in 36 (57.1%) patients, remained unchanged in 19 (30.2%) patients, and increased in 8 (12.7%) patients. Overall tumor control rate was 87.3%. Endocrinopathy-Free Survival was 47.1%, and tumor Progression-Free Survival was 93.3%, at 5 years. Five (4.6%) patients required additional treatment after GKRS. One (1.6%) patient each had worsening of headache, optic atrophy and cerebellar infarct after GKRS therapy.

Conclusion

GKRS offers a safe adjunctive treatment modality, with satisfactory long-term preservation of hormone functions and a high rate of tumor control, in patients with NFPA.

Ferrante E, Ferraroni M, Castrignanò T, Menicatti L, Anagni M, Reimondo G et al (2006) Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol 155(6):823–829. https://doi.org/10.1530/eje.1.02298CrossRefPubMed

Chang EF, Sughrue ME, Zada G, Wilson CB, Blevins LS Jr, Kunwar S (2010) Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 13(3):223–229. https://doi.org/10.1007/s11102-010-0221-zCrossRefPubMedPubMedCentral

Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation—a follow-up study. Clin Endocrinol (Oxf) 51(3):281–284. https://doi.org/10.1046/j.1365-2265.1999.00865.xCrossRef

Shen CC, You WC, Sun MH, Lee SD, Tsou HK, Chen YJ et al (2018) Outcome of partially irradiated recurrent nonfunctioning pituitary macroadenoma by gamma knife radiosurgery. J Neurooncol 139(3):767–775. https://doi.org/10.1007/s11060-018-2925-2CrossRefPubMed

Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL et al (2013) Gamma knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119(2):446–456. https://doi.org/10.3171/2013.3.JNS12766CrossRefPubMed

Peker S, Kurtkaya-Yapicier O, Kiliç T, Pamir MN (2005) Microsurgical anatomy of the lateral walls of the pituitary fossa. Acta Neurochir 147(6):649. https://doi.org/10.1007/s00701-005-0513-7CrossRef

Brochier S, Galland F, Kujas M, Parker F, Gaillard S, Raftopoulos C et al (2010) Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients. Eur J Endocrinol 163(2):193–200. https://doi.org/10.1530/EJE-10-0255CrossRefPubMed

Trifiletti DM, Dutta SW, Lee CC, Sheehan JP (2019) Pituitary tumor radiosurgery. Prog Neurol Surg 34:149–158. https://doi.org/10.1159/000493059CrossRefPubMed

Park KJ, Kano H, Parry PV, Niranjan A, Flickinger JC, Lunsford LD et al (2011) Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery 69(6):1188–1199. https://doi.org/10.1227/NEU.0b013e318222afedCrossRefPubMed

10.

Laws ER Jr, Fode NC, Redmond MJ (1985) Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients. J Neurosurg 63(6):823–9. https://doi.org/10.3171/jns.1985.63.6.0823CrossRefPubMed

11.

Narayan V, Mohammed N, Bir SC, Savardekar AR, Patra DP, Bollam P et al (2018) Long-term outcome of nonfunctioning and hormonal active pituitary adenoma after gamma knife radiosurgery. World Neurosurg 114:e824–e832. https://doi.org/10.1016/j.wneu.2018.03.094CrossRefPubMed

12.

Pollock BE, Cochran J, Natt N, Brown PD, Erickson D, Link MJ et al (2008) Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys 70(5):1325–1329. https://doi.org/10.1016/j.ijrobp.2007.08.018CrossRefPubMed

13.

Lee MH, Lee JH, Seol HJ, Lee JI, Kim JH, Kong DS et al (2016) Clinical concerns about recurrence of non-functioning pituitary adenoma. Brain Tumor Res Treat 4(1):1–7. https://doi.org/10.14791/btrt.2016.4.1.1CrossRefPubMedPubMedCentral

14.

Lee CC, Kano H, Yang HC, Xu Z, Yen CP, Chung WY et al (2014) Initial gamma knife radiosurgery for nonfunctioning pituitary adenomas. J Neurosurg 120(3):647–654. https://doi.org/10.3171/2013.11.JNS131757CrossRefPubMed

15.

Di Chiro G, Nelson KB (1962) The volume of the sella turcica. Am J Roentgenol Radium Ther Nucl Med 87:989–1008

16.

Hardy J, Vezina JL (1976) Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol 15:261–273PubMed

17.

Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33(4):610–7. https://doi.org/10.1227/00006123-199310000-00008CrossRefPubMed

18.

Albano L, Losa M, Barzaghi LR, Niranjan A, Siddiqui Z, Flickinger JC et al (2021) Gamma knife radiosurgery for pituitary tumors: a systematic review and meta-analysis. Cancers 13(19):4998. https://doi.org/10.3390/cancers13194998CrossRefPubMedPubMedCentral

19.

Deng Y, Li Y, Li X, Wu L, Quan T, Peng C et al (2020) Long-term results of gamma knife radiosurgery for postsurgical residual or recurrent nonfunctioning pituitary adenomas. Int J Med Sci 17(11):1532–1540. https://doi.org/10.7150/ijms.47168CrossRefPubMedPubMedCentral

20.

Sun S, Liu A, Zhang Y (2019) Long-term follow-up studies of gamma knife radiosurgery for postsurgical nonfunctioning pituitary Adenomas. World Neurosurg S1878–8750(19):30078–30086. https://doi.org/10.1016/j.wneu.2019.01.009CrossRef

21.

Sadik ZHA, Voormolen EHJ, Depauw PRAM, Burhani B, Nieuwlaat WA, Verheul J et al (2017) Treatment of nonfunctional pituitary adenoma postoperative remnants: adjuvant or delayed gamma knife radiosurgery? World Neurosurg 100:361–368. https://doi.org/10.1016/j.wneu.2017.01.028CrossRefPubMed

22.

Bir SC, Murray RD, Ambekar S, Bollam P, Nanda A (2015) Clinical and radiologic outcome of gamma knife radiosurgery on nonfunctioning pituitary adenomas. J Neurol Surg B Skull Base 76(5):351–357. https://doi.org/10.1055/s-0035-1549309CrossRefPubMedPubMedCentral

23.

Zeiler FA, Bigder M, Kaufmann A, McDonald PJ, Fewer D, Butler J, Schroeder G et al (2013) Gamma knife in the treatment of pituitary adenomas: results of a single center. Can J Neurol Sci 40(4):546–552. https://doi.org/10.1017/s0317167100014645CrossRefPubMed

24.

Liscák R, Vladyka V, Marek J, Simonová G, Vymazal J (2007) Gamma knife radiosurgery for endocrine-inactive pituitary adenomas. Acta Neurochir 149(10):999–1006. https://doi.org/10.1007/s00701-007-1253-7CrossRefPubMed

25.

Hayashi M, Chernov M, Tamura N, Nagai M, Yomo S, Ochiai T et al (2010) Gamma knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol 98(2):185–194. https://doi.org/10.1007/s11060-010-0172-2CrossRefPubMed

26.

Kara M, Yılmaz M, Şengöz M, Peker S (2021) Hormonal and radiologic outcomes after gamma knife radiosurgery for nonfunctioning pituitary adenomas. Br J Neurosurg 1:1–7. https://doi.org/10.1080/02688697.2021.1903388CrossRef

27.

Leenstra JL, Tanaka S, Kline RW, Brown PD, Link MJ, Nippoldt TB et al (2010) Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas. Neurosurgery 67(1):27–32. https://doi.org/10.1227/01.NEU.0000370978.31405.A9CrossRefPubMed

28.

Iwai Y, Yamanaka K, Yoshioka K (2005) Radiosurgery for nonfunctioning pituitary adenomas. Neurosurgery 56(4):699–705. https://doi.org/10.1227/01.neu.0000156836.42945.28CrossRefPubMed

29.

Gopalan R, Schlesinger D, Vance ML, Laws E, Sheehan J (2011) Long-term outcomes after gamma knife radiosurgery for patients with a nonfunctioning pituitary adenoma. Neurosurgery 69(2):284–293. https://doi.org/10.1227/NEU.0b013e31821bc44eCrossRefPubMed

30.

Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER et al (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104(6):876–883. https://doi.org/10.3171/jns.2006.104.6.876CrossRefPubMed

31.

Pomeraniec IJ, Dallapiazza RF, Xu Z, Jane JA Jr, Sheehan JP (2016) Early versus late gamma knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study. J Neurosurg 125(1):202–212. https://doi.org/10.3171/2015.5.JNS15581CrossRefPubMed

32.

Gala F (2015) Magnetic resonance imaging of optic nerve. Indian J Radiol Imaging 25(4):421–38. https://doi.org/10.4103/0971-3026.169462CrossRefPubMedPubMedCentral

33.

van Westrhenen A, Muskens IS, Verhoeff JJC, Smith TRS, Broekman MLD (2017) Ischemic stroke after radiation therapy for pituitary adenomas: a systematic review. J Neurooncol 135(1):1–11. https://doi.org/10.1007/s11060-017-2530-9CrossRefPubMedPubMedCentral

34.

Shin M, Kurita H, Sasaki T, Tago M, Morita A, Ueki K et al (2000) Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 93(Suppl 3):2–5. https://doi.org/10.3171/jns.2000.93.supplement_3.0002CrossRefPubMed

35.

Sattler MG, Meiners LC, Sluiter WJ, van den Berg G, Langendijk JA, Wolffenbuttel BH et al (2015) Brain abnormalities on MRI in non-functioning pituitary adenoma patients treated with or without postoperative radiotherapy. Radiother Oncol 114(2):239–244. https://doi.org/10.1016/j.radonc.2015.01.003CrossRefPubMed

36.

Sattler MG, Vroomen PC, Sluiter WJ, Schers HJ, van den Berg G, Langendijk JA et al (2013) Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone. Int J Radiat Oncol Biol Phys 87(1):53–59. https://doi.org/10.1016/j.ijrobp.2013.05.006CrossRefPubMed

37.

Pomeraniec IJ, Taylor DG, Cohen-Inbar O, Xu Z, Lee Vance M, Sheehan JP (2019) Radiation dose to neuroanatomical structures of pituitary adenomas and the effect of gamma knife radiosurgery on pituitary function. J Neurosurg 132(5):1499–1506. https://doi.org/10.3171/2019.1.JNS182296CrossRefPubMed

Titel: Long-term hormonal and imaging outcomes of adjunctive gamma knife radiosurgery in non-functioning pituitary adenomas: a single center experience
verfasst von: Aasim N. Maldar
Sanjeev Pattankar
Basant K. Misra
Phulrenu H. Chauhan
Milind Sankhe
Ketan Desai
N. F. Shah
Publikationsdatum: 20.05.2022
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 3/2022
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-022-04029-0

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