Skip to main content

Advertisement

Log in

Focal radiation therapy for patients with persistent/recurrent pituitary adenoma, despite previous radiotherapy

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

With the stricter endocrine definitions of cure following conventionally planned and fractionated radiotherapy for functioning pituitary adenomas, together with the move in the profession (since the advent of high quality MRI) to postpone radiation therapy until macroscopic disease appears after surgery, it is now realised that cure rates following conventional radiotherapy approximate three out of four rather than the >90% cited for more than a decade. Patients with persistent active tumours may be successfully further treated by focal radiation therapy by one of the stereotactic focal techniques. We have experience of such re-treatment radiation therapy in 50 patients. With careful case selection, we here demonstrate that in acromegaly, for example, normalisation of both GH and IGF levels may be achieved in 37–58% of these previously irradiated patients with low risk of late morbidity. Unquestionably, growth delay occurs in many cases but the long term tumour control rate has yet to be established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Laws ER, Jane JA (2005) Neurosurgical approach to treating pituitary adenomas. Growth Horm IGF Res 15:S36–S41. doi:10.1016/j.ghir.2005.06.008

    Article  PubMed  Google Scholar 

  2. Elias WJ, Chadduck JB, Alden TD, Laws ER (1999) Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45:271–275. doi:10.1097/00006123-199908000-00015

    Article  PubMed  CAS  Google Scholar 

  3. Carrau RL, Jho HD, Ko Y (1996) Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918. doi:10.1097/00005537-199607000-00025

    Article  PubMed  CAS  Google Scholar 

  4. de Divitiis E (2006) Endoscopic transsphenoidal surgery: stone-in-the-pond effect. Neurosurgery 59:512–520. doi:10.1227/01.NEU.0000227475.69682.77

    Article  PubMed  Google Scholar 

  5. Jane JA, Thapar K, Kaptain G et al (2002) Pituitary surgery: transsphenoidal approach. Neurosurgery 51:435–444. doi:10.1097/00006123-200208000-00025

    Article  PubMed  Google Scholar 

  6. Beclere J (1909) The radiotherapeutic treatment of tumours of the hypophysis, gigantism and acromegaly. Arch Roentgen Ray III:114

  7. Gramegna A (1909) Un cas d’acromegalie traité par la radiotherapie. Rev Neurol (Paris) 17:15

    Google Scholar 

  8. Plowman PN (1999) Pituitary adenoma radiotherapy—when, who and how? Clin Endocrinol (Oxf) 51:265–271. doi:10.1046/j.1365-2265.1999.00854.x

    Article  CAS  Google Scholar 

  9. Brada M, Rajan B, Traish D et al (1993) The long term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 38:571–578

    Article  CAS  Google Scholar 

  10. Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab. 90:800–804. doi:10.1210/jc.2004-1152

    Article  PubMed  CAS  Google Scholar 

  11. Plowman PN (1999) Pituitary adenoma radiotherapy—when, who and how? Clin Endocrinol (Oxf) 51:265–271. doi:10.1046/j.1365-2265.1999.00854.x

    Article  CAS  Google Scholar 

  12. Schoenthaler R, Albright NW, Wara WM, Phillips TL, Wilson CB, Larson DA (1992) Reirradiation of pituitary adenoma. Int J Radiat Oncol Biol Phys 24:307–314

    PubMed  CAS  Google Scholar 

  13. Ronson BB, Schulte RW, Han KP, Loredo LN, Slater JM, Slater JD (2006) Fractionated proton beam irradiation of pituitary adenomas. Int J Radiat Oncol Biol Phys 64:425–434. doi:10.1016/j.ijrobp.2005.07.978

    PubMed  Google Scholar 

  14. Swords FM, Allan CA, Plowman PN et al (2003) Stereotactic radiosurgery XVI: a treatment for previously irradiated pituitary adenomas. J Clin Endocrinol Metab 88:5334–5340. doi:10.1210/jc.2002-020356

    Article  PubMed  CAS  Google Scholar 

  15. Swords FM, Monson JP, Besser GM, Chew SL, Drake WM, Grossman AB, Plowman PN (2008) Gamma knife radiosurgery: a safe and effective treatment for acromegaly (submitted to British Endocrine Society)

  16. Blackburn TPD, Swords FM, Buchipudi R, Edwards A, Plowman PN, Sabin HI (2007) Gamma knife radiosurgery after previous radiotherapy for pituitary adenomas. Proc. Europ. Gamma knife Soc (Abstract)

  17. Mingione V, Yen CP, Vance ML et al (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:876–883. doi:10.3171/jns.2006.104.6.876

    Article  PubMed  Google Scholar 

  18. Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML (2007) Gamma knife surgery for Cushing’s disease. J Neurosurg 106:980–987. doi:10.3171/jns.2007.106.6.980

    Article  PubMed  Google Scholar 

  19. Pan L, Zhang N, Wang E, Wang B, Xu W (1998) Pituitary adenomas: the effect of gamma knife radiosurgery on tumor growth and endocrinopathies. Stereotact Funct Neurosurg 70s1:119–26

    Article  Google Scholar 

  20. Adler JR, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession CyberKnife radiosurgery for perioptic lesions. Neurosurg 59:244–254. doi:10.1227/01.NEU.0000223512.09115.3E

    Article  Google Scholar 

  21. Castinetti F, Nagai M, Dufour H et al (2007) Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease. Eur J Endocrinol 156:91–98. doi:10.1530/eje.1.02323

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P. N. Plowman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Edwards, A.A., Swords, F.M. & Plowman, P.N. Focal radiation therapy for patients with persistent/recurrent pituitary adenoma, despite previous radiotherapy. Pituitary 12, 30–34 (2009). https://doi.org/10.1007/s11102-008-0115-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-008-0115-5

Keywords

Navigation