Journal ArticleDOI
Dose to neuroanatomical structures surrounding pituitary adenomas and the effect of stereotactic radiosurgery on neuroendocrine function: an international multicenter study.
I. Jonathan Pomeraniec,Zhiyuan Xu,Cheng-Chia Lee,Huai-Che Yang,Tomas Chytka,Roman Liscak,Roberto Martinez-Alvarez,Nuria Martinez-Moreno,Luca Attuati,Piero Picozzi,Douglas Kondziolka,Monica Mureb,Kenneth E. Bernstein,David Mathieu,Michel Maillet,Akiyoshi Ogino,Hao Long,Hideyuki Kano,L. Dade Lunsford,Brad E. Zacharia,Christine Mau,Leonard Tuanquin,Christopher P. Cifarelli,David E. Arsanious,Joshua D Hack,Ronald E Warnick,Ben A Strickland,Gabriel Zada,Eric L. Chang,Herwin Speckter,Samir Patel,Dale Ding,Darrah Sheehan,Kimball Sheehan,Svetlana Kvint,Love Buch,Alexander R Haber,Jacob Shteinhart,Mary Lee Vance,Jason P. Sheehan +39 more
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TLDR
In this paper, a retrospective review of patients with pituitary adenomas who underwent single-fraction stereotactic radiosurgery (SRS) from 1997 to 2019 at 16 institutions within the International Radiosurgery Research Foundation (IRRF).Abstract:
Objective Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism after SRS. In this multicenter study by the International Radiosurgery Research Foundation (IRRF), the authors aimed to evaluate radiation tolerance of structures surrounding pituitary adenomas and identify predictors of delayed hypopituitarism after SRS for these tumors. Methods This is a retrospective review of patients with pituitary adenomas who underwent single-fraction SRS from 1997 to 2019 at 16 institutions within the IRRF. Dosimetric point measurements of 14 predefined neuroanatomical structures along the hypothalamus, pituitary stalk, and normal pituitary gland were made. Statistical analyses were performed to determine the impact of doses to critical structures on clinical, radiographic, and endocrine outcomes. Results The study cohort comprised 521 pituitary adenomas treated with SRS. Tumor control was achieved in 93.9% of patients over a median follow-up period of 60.1 months, and 22.5% of patients developed new loss of pituitary function with a median treatment volume of 3.2 cm3. Median maximal radiosurgical doses to the hypothalamus, pituitary stalk, and normal pituitary gland were 1.4, 7.2, and 11.3 Gy, respectively. Nonfunctioning adenoma status, younger age, higher margin dose, and higher doses to the pituitary stalk and normal pituitary gland were independent predictors of new or worsening hypopituitarism. Neither the dose to the hypothalamus nor the ratio between doses to the pituitary stalk and gland were significant predictors. The threshold of the median dose to the pituitary stalk for new endocrinopathy was 10.7 Gy in a single fraction (OR 1.77, 95% CI 1.17-2.68, p = 0.006). Conclusions SRS for the treatment of pituitary adenomas affords a high tumor control rate with an acceptable risk of new or worsening endocrinopathy. This evaluation of point dosimetry to adjacent neuroanatomical structures revealed that doses to the pituitary stalk, with a threshold of 10.7 Gy, and doses to the normal gland significantly increased the risk of post-SRS hypopituitarism. In patients with preserved pre-SRS neuroendocrine function, limiting the dose to the pituitary stalk and gland while still delivering an optimal dose to the tumor appears prudent.read more
Citations
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Role of radiosurgery in the treatment of Cushing's disease
TL;DR: Hypopituitarism is the most frequent side effect of GKRS, whereas severe neurologic complications are uncommon in radiation‐naïve patients.
Journal ArticleDOI
Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis
Paolo Palmisciano,Christian T Ogasawara,Maya Ogasawara,Gianluca Ferini,Gianluca Scalia,Ali Haider,Othman Bin Alamer,Maurizio Salvati,Giuseppe Emmanuele Umana +8 more
TL;DR: Primary GKRS for pituitary adenoma may correlate with lower rates of radiation-induced hypopituitarism than post-surgery GK RS, and minimal doses to normal pituitsary structures and long-term endocrine follow-up are of primary importance.
Journal ArticleDOI
Adjuvant versus on-progression Gamma Knife radiosurgery for residual nonfunctioning pituitary adenomas: a matched-cohort analysis.
Georgios Mantziaris,Stylianos Pikis,Tomas Chytka,Roman Liscak,Kimball Sheehan,Darrah Sheehan,Selçuk Peker,Yavuz Samanci,Shray K. Bindal,Ajay Niranjan,L. Dade Lunsford,Rupinder Kaur,Renu Madan,Manjul Tripathi,Dhiraj J. Pangal,Ben A. Strickland,Gabriel Zada,Anne-Marie Langlois,David Mathieu,Ronald E. Warnick,Samir H. Patel,Zayda Minier,H. Speckter,Zhiyuan Xu,Rithika Kormath Anand,Jason P. Sheehan +25 more
TL;DR: In this article , the optimal timing of Stereotactic radiosurgery (SRS) for residual NFPAs was defined and compared with adjuvant SRS, and the median time from resection to new hypopituitarism was longer in the Progression (58.9 vs 29.7 months, p = 0.004).
Journal ArticleDOI
Individualized acromegaly treatment: Is stereotactic radiation therapy changing the paradigm?
Winnie Liu,Maria Fleseriu +1 more
TL;DR: Liu and Fleseriu as discussed by the authors published an open-access article under the terms of the Creative Commons Attribution License (CC BY), which allows the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owners are credited and that the original publication in this journal is cited.
Journal ArticleDOI
Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study
Natasha Ironside,Ching-Jen Chen,Zhiyuan Xu,David Schlesinger,Mary Lee Vance,Gregory K. Hong,John A. Jane,Samir H. Patel,Shray K. Bindal,Ajay Niranjan,L. Dade Lunsford,Roman Liscak,Thomas Chytka,Jana Ježková,Omran Saifi,Daniel M. Trifiletti,Assaf Berger,Juan Alzate,Kenneth E. Bernstein,Douglas Kondziolka,H. Speckter,Wenceslao Hernández,E.V. Lazo,Selçuk Peker,Yavuz Samanci,Brad E. Zacharia,Christine Mau,Rodney E. Wegner,Matthew J. Shepard,David Mathieu,Michel Maillet,Jason P. Sheehan +31 more
TL;DR: In this paper , the authors investigated the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study and found that the optimal distance between the center of the pituitar stalk and the tumor margin isodose ≥ 3.95 mm was ≥ 2.5 mm.
References
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Journal ArticleDOI
The prevalence of pituitary adenomas: a systematic review.
Shereen Ezzat,Sylvia L. Asa,William T. Couldwell,M.P.H. Charles E. Barr M.D.,M.B.A. William E. Dodge M.S.,Mary Lee Vance,Ian E. McCutcheon +6 more
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TL;DR: The long‐term efficacy and toxicity of conservative surgery and radiotherapy in the control of pituitary adenomas is assessed.
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TL;DR: In this paper, the frequency of false positive results in imaging diagnoses of a functioning pituitary microadenoma was investigated and the authors studied various kinds of incidental lesions greater than 2 mm in diameter from a larger series of Pituitary glands.
Journal ArticleDOI
Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy
Alex M. Landolt,Dieter Haller,Nicoletta Lomax,Stefan Scheib,Othmar Schubiger,Jean Siegfried,Georgios N. Wellis +6 more
TL;DR: The authors suggest the use of stereotactic radiosurgery as the preferred treatment for recurrent acromegaly resulting from unsuccessfully resected tumors.
Journal ArticleDOI
Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium.
Jason P. Sheehan,Ajay Niranjan,Jonas M. Sheehan,John A. Jane,Edward R. Laws,Douglas Kondziolka,John C. Flickinger,Alex M. Landolt,Jay S. Loeffler,L. Dade Lunsford +9 more
TL;DR: Although microsurgery remains the primary treatment modality in most cases, stereotactic radiosurgery offers both safe and effective treatment for recurrent or residual pituitary adenomas.