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Endocrine and visual function after fractionated stereotactic radiotherapy of perioptic tumors

Endokrine und visuelle Funktion nach fraktionierter stereotaktischer Strahlenbehandlung perioptischer Tumoren

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Abstract

Purpose

To find out whether the use of stereotactic techniques for fractionated radiotherapy reduces toxicity to the endocrine and visual system in patients with benign perioptic tumors.

Patients and methods

From 1993 to 2009,  29 patients were treated with fractionated stereotactic radiotherapy. The most frequent tumor types were grade I meningioma (n  = 11) and pituitary adenoma (n  = 10, 7 nonfunctioning, 3 growth hormone-producing). Patients were immobilized with the GTC frame (Radionics, USA) and the planning target volume (PTV; median 24.7, 4.6–58.6 ml) was irradiated with a total dose of 52.2 Gy (range, 45.0–55.8 Gy) in 1.8-Gy fractions using a linear accelerator (6 MeV photons) equipped with a micro-multileaf collimator. Maximum doses to the optic system and pituitary gland were 53.4 Gy (range, 11.5–57.6 Gy) and 53.6 Gy (range, 12.0–57.9 Gy).

Results

Median follow-up was 45 months (range, 10–105 months). Local control was achieved in all but 1 patient (actuarial rate 92% at 5 years and 10 years). In 9 of 29 patients (31%), partial remission was observed (actuarial response rate 40% at 5 years and 10 years). In 4 of 26 patients (15%) with at least partial pituitary function, new hormonal deficits developed (actuarial rate 21% at 5 years and 10 years). This rate was significantly higher in patients treated for a larger PTV (< /> 25 ml: 0% vs. 42% at 5 years and 10 years, p = 0.028). Visual function improved in 4 of 15 patients (27%) who had prior impairment. None of the patients developed treatment-related optic neuropathy, but 2 patients experienced new disease-related visual deficits.

Conclusion

Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors.

Zusammenfassung

Ziel

Zu untersuchen, ob die Anwendung stereotaktischer Techniken bei der fraktionierten Bestrahlung die endokrine und visuelle Toxizität bei der Behandlung von benignenTumoren in der Nähe des optischen Systems reduziert.

Patienten und Methoden

Von1993 bis 2009 wurden n = 29 Patienten (Pat.) behandelt (überwiegend Meningeome Grad I, n = 11, und Hypophysenadenome, n = 10, 7 inaktiv, 3 STH-produzierend). Zur Immobilisierung wurde der GTC-Stereotaxierahmen (Radionics, USA) verwendet. Die Bestrahlung erfolgte an einem Linearbeschleuniger (6 MeV) mit einem motorischen Mikromultileaf-Kollimator. Das Planungs-Zielvolumen (PTV; Median: 24,7 ml, 4,6–58,6 ml) wurde mit einer Gesamtdosis von 52,2 Gy (45,0–55,8 Gy) in Fraktionen von 1,8 Gy bestrahlt. Die Maximaldosis betrug im optischen System 53,4 Gy (11,5–57,6 Gy) und an der Hypophyse 53,6 Gy (12,0–57,9 Gy).

Ergebnisse

Mit einem medianen Follow-up von 45 (10–105) Monaten lag die lokale Kontrollrate nach 5 und 10 Jahren bei 92%. Bei 9/29 (31%) Pat. kam es zu einer partiellen Remission (aktuarisch 40% nach 5 und 10 Jahren). Bei den Pat. mit einer erhaltenen Restfunktion der Hypophyse traten in 15% der Fälle (4/26) neue endokrinologische Ausfälle auf (aktuarisch 21% nach 5 und 10 Jahren), diese Rate war signifikant abhängig von der Größe des PTV (< /> 25 ml: 0% vs. 42% nach 5 Jahren und 10 Jahren, p = 0,028). Die visuelle Funktion verbesserte sich bei 4/15 Pat. (27%) mit vorbestehenden Ausfällen. Kein Pat. entwickelte eine Optikusneuropathie, aber bei 2 Pat. trat eine krankheitsbedingte Sehverschlechterung ein.

Schlussfolgerung

Die stereotaktische fraktionierte Strahlenbehandlung von benignen Tumoren in der Nähe von Sella und optischem System führt zu guten Ansprech- und Kontrollraten und beeinträchtigt das visuelle System nicht. Eine therapiebedingte Hypophysenvorderlappeninsuffizienz kann aber nur bei kleinen Tumoren weitgehend vermieden werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, UniKlinik Köln, Joseph-Stelzmann-Str. 9, 50924, Cologne, Deutschland

    M. Kocher, R. Semrau & R.-P. Mueller

  2. Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany

    H. Treuer, M. Hoevels & V. Sturm

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  1. M. Kocher
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  2. H. Treuer
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  3. M. Hoevels
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  4. R. Semrau
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  5. V. Sturm
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  6. R.-P. Mueller
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Correspondence to M. Kocher.

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Kocher, M., Treuer, H., Hoevels, M. et al. Endocrine and visual function after fractionated stereotactic radiotherapy of perioptic tumors. Strahlenther Onkol 189, 137–141 (2013). https://doi.org/10.1007/s00066-012-0269-y

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  • DOI: https://doi.org/10.1007/s00066-012-0269-y

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