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Long-term hormonal and imaging outcomes of adjunctive gamma knife radiosurgery in non-functioning pituitary adenomas: a single center experience

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Abstract

Purpose

Gamma Knife Radiosurgery(GKRS) is an established modality for treatment of non-functioning pituitary adenomas(NFPA). The objective of the study was to assess long-term hormonal and imaging outcomes after adjunctive GKRS in patients with NFPA.

Methods

A retrospective review of records of 109 patients with NFPA, from 1996 to 2020, who received adjunctive GKRS, was performed. Patients who had received GKRS as the primary modality of treatment for NFPA were not included.

Results

Sixty-three (57.8%) patients were available for follow up at our institute. The median follow-up period was 47 months (range, 6–260). At a median time of 38 months (range, 8–97), 25 (39.7%) patients developed ≥ 1 new pituitary hormone deficiency. Median time to cortisol deficiency was 38 months (range, 8–55), thyroid hormone deficiency was 45.5 months (range, 12–97) and gonadotropin deficiency was 45 months (range, 21–75). The actuarial risk of developing a new pituitary hormone deficit at 1, 3, 5, 7, and 10 years was 2.5%, 11%, 26.3%, 28% and 29.7%, respectively. Adenoma size decreased in 36 (57.1%) patients, remained unchanged in 19 (30.2%) patients, and increased in 8 (12.7%) patients. Overall tumor control rate was 87.3%. Endocrinopathy-Free Survival was 47.1%, and tumor Progression-Free Survival was 93.3%, at 5 years. Five (4.6%) patients required additional treatment after GKRS. One (1.6%) patient each had worsening of headache, optic atrophy and cerebellar infarct after GKRS therapy.

Conclusion

GKRS offers a safe adjunctive treatment modality, with satisfactory long-term preservation of hormone functions and a high rate of tumor control, in patients with NFPA.

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Acknowledgements

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Funding

This research did not receive any specific grant or financial contribution from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Endocrinology, P.D. Hinduja Hospital and Medical Research Center, Mumbai, 400016, India

    Aasim N. Maldar, Phulrenu H. Chauhan & N. F. Shah

  2. Department of Neurosurgery & Gamma Knife Radiosurgery, P.D. Hinduja Hospital and Medical Research Center, Mumbai, 400016, India

    Sanjeev Pattankar, Basant K. Misra, Milind Sankhe & Ketan Desai

  3. Department of Surgery, P.D. Hinduja Hospital and Medical Research Center, Mumbai, 400016, India

    Basant K. Misra

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  1. Aasim N. Maldar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. ANM and Dr. SP. The first draft of the manuscript was written by Dr. ANM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Phulrenu H. Chauhan.

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The authors declare that they have no known competing financial interest or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

Ethical approval was waived by the local Ethics Committee of P. D. Hinduja Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Maldar, A.N., Pattankar, S., Misra, B.K. et al. Long-term hormonal and imaging outcomes of adjunctive gamma knife radiosurgery in non-functioning pituitary adenomas: a single center experience. J Neurooncol 158, 423–433 (2022). https://doi.org/10.1007/s11060-022-04029-0

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