Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes
- 1 February 2011
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 114 (2), 303-309
- https://doi.org/10.3171/2010.5.jns091635
Abstract
Gamma Knife surgery (GKS) is a common treatment for recurrent or residual pituitary adenomas. This study evaluates a large cohort of patients with a pituitary adenoma to characterize factors related to endocrine remission, control of tumor growth, and development of pituitary deficiency. A total of 418 patients who underwent GKS with a minimum follow-up of 6 months (median 31 months) and for whom there was complete follow-up were evaluated. Statistical analysis was performed to evaluate for significant factors (p < 0.05) related to treatment outcomes. In patients with a secretory pituitary adenoma, the median time to endocrine remission was 48.9 months. The tumor margin radiation dose was inversely correlated with time to endocrine remission. Smaller adenoma volume correlated with improved endocrine remission in those with secretory adenomas. Cessation of pituitary suppressive medications at the time of GKS had a trend toward statistical significance in regard to influencing endocrine remission. In 90.3% of patients there was tumor control. A higher margin radiation dose significantly affected control of adenoma growth. New onset of a pituitary hormone deficiency following GKS was seen in 24.4% of patients. Treatment with pituitary hormone suppressive medication at the time of GKS, a prior craniotomy, and larger adenoma volume at the time of radiosurgery were significantly related to loss of pituitary function. Smaller adenoma volume improves the probability of endocrine remission and lowers the risk of new pituitary hormone deficiency with GKS. A higher margin dose offers a greater chance of endocrine remission and control of tumor growth.Keywords
This publication has 35 references indexed in Scilit:
- GAMMA KNIFE RADIOSURGERY FOR ACROMEGALYNeurosurgery, 2008
- Hypopituitarism following radiotherapyPituitary, 2008
- Gamma Knife surgery for Cushing's diseaseJournal of Neurosurgery, 2007
- Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s diseaseActa Endocrinologica, 2007
- Glucose Homeostasis and Safety in Patients with Acromegaly Converted from Long-Acting Octreotide to PegvisomantJournal of Clinical Endocrinology & Metabolism, 2005
- Surgical Outcomes in Hyporesponsive Prolactinomas: Analysis of patients with Resistance or Intolerance to Dopamine AgonistsPituitary, 2005
- Hormonal and Metabolic Effects of Radiotherapy in Acromegaly: Long-Term Results in 128 Patients Followed in a Single CenterJournal of Clinical Endocrinology & Metabolism, 2000
- The Effects of Gamma Knife Surgery of Pituitary Adenomas on Tumor Growth and EndocrinopathiesStereotactic and Functional Neurosurgery, 1993
- Repeat transsphenoidal surgery for Cushing's diseaseJournal of Neurosurgery, 1989
- Surgical treatment of Cushing's diseaseJournal of Neurosurgery, 1987