Long-term Outcomes After Gamma Knife Stereotactic Radiosurgery for Nonfunctional Pituitary Adenomas

• Published in: Neurosurgery Vol. 69; no. 6; pp. 1188 - 1199
• Main Authors: Park, Kyung-Jae, Kano, Hideyuki, Parry, Phillip V., Niranjan, Ajay, Flickinger, John C., Lunsford, L. Dade, Kondziolka, Douglas
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01-12-2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Adenoma - mortality; Adenoma - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Disease-Free Survival; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurosurgery; Patients; Pituitary Neoplasms - mortality; Pituitary Neoplasms - surgery; Radiation therapy; Radiosurgery - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Tumors; Young Adult; Stereotactic radiosurgery; Gamma Knife; Nonfunctional tumor; Pituitary adenoma; Endocrinopathy; Nervous system diseases; Prognosis; Surgery; Pituitary diseases; Radiosurgery; Stereotaxia; Tumor
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e318222afed

Abstract
BACKGROUND
Nonfunctional pituitary adenomas (NFPAs) represent approximately 50% of all pituitary tumors.
OBJECTIVE
To evaluate the long-term outcomes of stereotactic radiosurgery for NFPAs.
METHODS
We evaluated the management outcomes of Gamma Knife radiosurgery in 125 patients with NFPAs over an interval of 22 years. The median patient age was 54 years (range, 16-88 years). One hundred ten patients (88%) had residual or recurrent tumors after ≥ 1 surgical procedures, and 17 (14%) had undergone prior fractionated radiation therapy. The median target volume was 3.5 cm3 (range, 0.4-28.1 cm3), and the median tumor margin dose was 13.0 Gy (range, 10-25 Gy).
RESULTS
Tumor volume decreased in 66 patients (53%), remained stable in 46 (37%), and increased in 13 (10.4%) during a median of 62 months (maximum, 19 years) of imaging follow-up. The actuarial tumor control rates at 1, 5, and 10 years were 99%, 94%, and 76%, respectively. Factors associated with a reduced progression-free survival included larger tumor volume (≥ 4.5 cm3) and ≥ 2 prior recurrences. Of 88 patients with residual pituitary function, 21 (24%) suffered new hormonal deficits at a median of 24 months (range, 3-114 months). Prior radiation therapy increased the risk of developing new pituitary hormonal deficits. One patient (0.8%) had a decline in visual function, and 2 (1.6%) developed new cranial neuropathies without tumor progression.
CONCLUSION
Stereotactic radiosurgery can provide effective management for patients with newly diagnosed NFPAs and for those after prior resection and/or radiation therapy.