Postsurgical Salvage Radiosurgery for Nonfunctioning Pituitary Adenomas Touching/Compressing the Optic Chiasm: Median 13-Year Postirradiation Imaging Follow-up Results.
Adenoma
/ complications
Adult
Aged
Aged, 80 and over
Disease Progression
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
/ trends
Male
Middle Aged
Optic Chiasm
/ diagnostic imaging
Pituitary Neoplasms
/ complications
Radiosurgery
/ methods
Retrospective Studies
Salvage Therapy
/ methods
Tumor Burden
/ physiology
Young Adult
Gamma knife
Pituitary adenoma
Radiation therapy
Radiosurgery
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 10 2019
01 10 2019
Historique:
received:
22
03
2018
accepted:
11
07
2018
pubmed:
1
9
2018
medline:
31
3
2020
entrez:
1
9
2018
Statut:
ppublish
Résumé
There is little information on long-term outcomes after salvage treatment by either surgery or stereotactic radiosurgery (SRS) for patients with recurrent/residual nonfunctioning pituitary adenomas (NFPAs). To reappraise the efficacy and safety of SRS for patients with NFPAs touching/compressing the optic apparatus (OA). We studied 27 patients (14 females, 13 males; mean age: 61 [range, 19-85] yr) who underwent SRS between 1998 and 2008 for NFPAs with such condition. The median tumor volume was 4.9 (range, 1.8-50.8) cc. To avoid excess irradiation to the OA, the lower part of the tumor was covered with a 50% or a 60% isodose gradient, ie 49% to 98% (mean, 84%; median, 88%) of the entire tumor received the selected doses. Median doses at the tumor periphery/OA were 7.6/11.0 (interquartile range [IQR], 5.8-9.1/10.1-11.8) Gy. Seven patients (26%) were confirmed to be deceased due to unrelated diseases at a median post-SRS period of 149 (IQR, 83-158) mo. Follow-up magnetic resonance imaging (MRI) showed tumor growth in 2 patients (7%) at the 11th and 134th post-SRS month; the former underwent surgery and the other SRS. Excluding these 2 patients, the latest follow-up MRI examinations, performed 13 to 238 (median: 168, IQR: 120-180) mo after SRS, showed no size changes in 5 (19%) and shrinkage in 20 (74%) patients. Cumulative incidences of tumor growth control were 96.3% and 91.8% at the 120th and 180th post-SRS month. None of our patients developed subjective symptoms suggesting SRS-induced optic neuropathy or endocrinological impairment. In patients with NFPAs touching/compressing the OA, SRS achieves good long-term results.
Sections du résumé
BACKGROUND
There is little information on long-term outcomes after salvage treatment by either surgery or stereotactic radiosurgery (SRS) for patients with recurrent/residual nonfunctioning pituitary adenomas (NFPAs).
OBJECTIVE
To reappraise the efficacy and safety of SRS for patients with NFPAs touching/compressing the optic apparatus (OA).
METHODS
We studied 27 patients (14 females, 13 males; mean age: 61 [range, 19-85] yr) who underwent SRS between 1998 and 2008 for NFPAs with such condition. The median tumor volume was 4.9 (range, 1.8-50.8) cc. To avoid excess irradiation to the OA, the lower part of the tumor was covered with a 50% or a 60% isodose gradient, ie 49% to 98% (mean, 84%; median, 88%) of the entire tumor received the selected doses. Median doses at the tumor periphery/OA were 7.6/11.0 (interquartile range [IQR], 5.8-9.1/10.1-11.8) Gy.
RESULTS
Seven patients (26%) were confirmed to be deceased due to unrelated diseases at a median post-SRS period of 149 (IQR, 83-158) mo. Follow-up magnetic resonance imaging (MRI) showed tumor growth in 2 patients (7%) at the 11th and 134th post-SRS month; the former underwent surgery and the other SRS. Excluding these 2 patients, the latest follow-up MRI examinations, performed 13 to 238 (median: 168, IQR: 120-180) mo after SRS, showed no size changes in 5 (19%) and shrinkage in 20 (74%) patients. Cumulative incidences of tumor growth control were 96.3% and 91.8% at the 120th and 180th post-SRS month. None of our patients developed subjective symptoms suggesting SRS-induced optic neuropathy or endocrinological impairment.
CONCLUSION
In patients with NFPAs touching/compressing the OA, SRS achieves good long-term results.
Identifiants
pubmed: 30169702
pii: 5087980
doi: 10.1093/neuros/nyy357
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
476-485Informations de copyright
Copyright © 2018 by the Congress of Neurological Surgeons.