Journal of Neuro-Oncology

, Volume 117, Issue 3, pp 445–457 | Cite as

Treatment paradigms for pituitary adenomas: defining the roles of radiosurgery and radiation therapy

  • Dale Ding
  • Robert M. Starke
  • Jason P. Sheehan
Topic Review


Pituitary adenomas represent one of the most common types of intracranial tumors. While their macroscopic appearance and anatomical location are relatively homogeneous, pituitary tumors have the potential to generate a wide variety of clinical sequelae. Treatment options for pituitary tumors include medical therapy, microscopic or endoscopic surgical resection, radiosurgery, radiation therapy, or observation depending on the biochemical profile and clinical status of the patient. Radiosurgery and external beam radiation therapy (EBRT) are most commonly as adjunctive treatments following incomplete surgical resection leaving residual tumor, tumor recurrence, or failure of medical therapy. We present a comprehensive literature review of the radiosurgery series for pituitary tumors including nonfunctioning adenomas, ACTH- and GH-secreting adenomas, and prolactinomas. While post-radiosurgery radiographic tumor control for nonfunctioning adenomas is excellent, typically around 90 %, the rates of biochemical remission for functioning adenomas are lower than the tumor control rates. The highest endocrine remission rates are achieved patients with Cushing’s disease and the lowest in those with prolactinomas. Although EBRT has been largely supplanted by radiosurgery for the vast majority of pituitary adenomas cases, there remains a role for EBRT in select cases involving large tumor volumes in close proximity to critical neural structures. By far the most common complication after radiosurgery or EBRT is delayed hypopituitarism followed by cranial neuropathies. The effect of suppressive medications on radiosurgery outcomes remains controversial. Due to the rare but well-documented occurrence of late recurrence following endocrine remission, long-term and rigorous clinical and radiographic follow-up is necessary for all pituitary adenoma patients treated with radiosurgery or EBRT.


Pituitary neoplasms Prolactinoma Acromegaly Cushing’s disease Radiotherapy Radiosurgery 


Conflict of interest

The authors have no relevant conflict of interest related to this work.


  1. 1.
    Dekkers OM, Pereira AM, Romijn JA (2008) Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab 93(10):3717–3726. doi: 10.1210/jc.2008-0643 PubMedCrossRefGoogle Scholar
  2. 2.
    Vance ML (2004) Treatment of patients with a pituitary adenoma: one clinician’s experience. Neurosurg Focus 16(4):E1PubMedCrossRefGoogle Scholar
  3. 3.
    Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102(4):316–319PubMedGoogle Scholar
  4. 4.
    Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun MP, Lunsford LD, Schulder M, Sloan AE (2007) Stereotactic radiosurgery–an organized neurosurgery-sanctioned definition. J Neurosurg 106(1):1–5. doi: 10.3171/jns.2007.106.1.1 PubMedCrossRefGoogle Scholar
  5. 5.
    Friedman WA, Foote KD (2000) Linear accelerator radiosurgery in the management of brain tumours. Ann Med 32(1):64–80PubMedCrossRefGoogle Scholar
  6. 6.
    Chen CC, Chapman P, Petit J, Loeffler J (2007) Proton radiosurgery in neurosurgery. Neurosurg Focus 23(6):E5. doi: 10.3171/FOC-07/12/E5 PubMedCrossRefGoogle Scholar
  7. 7.
    Hoybye C, Rahn T (2009) Adjuvant Gamma Knife radiosurgery in non-functioning pituitary adenomas; low risk of long-term complications in selected patients. Pituitary 12(3):211–216. doi: 10.1007/s11102-008-0163-x PubMedCrossRefGoogle Scholar
  8. 8.
    Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of Gamma Knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97(5 Suppl):415–421. doi: 10.3171/jns.2002.97 PubMedGoogle Scholar
  9. 9.
    Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 97(5 Suppl):408–414. doi: 10.3171/jns.2002.97 PubMedGoogle Scholar
  10. 10.
    Wowra B, Stummer W (2002) Efficacy of Gamma Knife radiosurgery for nonfunctioning pituitary adenomas: a quantitative follow up with magnetic resonance imaging-based volumetric analysis. J Neurosurg 97(5 Suppl):429–432. doi: 10.3171/jns.2002.97 PubMedGoogle Scholar
  11. 11.
    Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML (2003) Gamma Knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53((1):51–59PubMedCrossRefGoogle Scholar
  12. 12.
    Losa M, Valle M, Mortini P, Franzin A, da Passano CF, Cenzato M, Bianchi S, Picozzi P, Giovanelli M (2004) Gamma Knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg 100(3):438–444. doi: 10.3171/jns.2004.100.3.0438 PubMedCrossRefGoogle Scholar
  13. 13.
    Muacevic A, Uhl E, Wowra B (2004) Gamma Knife radiosurgery for nonfunctioning pituitary adenomas. Acta Neurochir Suppl 91:51–54PubMedGoogle Scholar
  14. 14.
    Kajiwara K, Saito K, Yoshikawa K, Kato S, Akimura T, Nomura S, Ishihara H, Suzuki M (2005) Image-guided stereotactic radiosurgery with the cyber knife for pituitary adenomas. Minim Invasive Neurosurg 48(2):91–96. doi: 10.1055/s-2004-830261 PubMedCrossRefGoogle Scholar
  15. 15.
    Picozzi P, Losa M, Mortini P, Valle MA, Franzin A, Attuati L, Ferrari da Passano C, Giovanelli M (2005) Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas. J Neurosurg 102(Suppl):71–74PubMedCrossRefGoogle Scholar
  16. 16.
    Iwai Y, Yamanaka K, Yoshioka K (2005) Radiosurgery for nonfunctioning pituitary adenomas. Neurosurgery 56(4):699–705PubMedCrossRefGoogle Scholar
  17. 17.
    Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER, Steiner L (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104(6):876–883. doi: 10.3171/jns.2006.104.6.876 PubMedCrossRefGoogle Scholar
  18. 18.
    Voges J, Kocher M, Runge M, Poggenborg J, Lehrke R, Lenartz D, Maarouf M, Gouni-Berthold I, Krone W, Muller RP, Sturm V (2006) Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study. Cancer 107(6):1355–1364. doi: 10.1002/cncr.22128 PubMedCrossRefGoogle Scholar
  19. 19.
    Liscak R, Vladyka V, Marek J, Simonova G, Vymazal J (2007) Gamma Knife radiosurgery for endocrine-inactive pituitary adenomas. Acta Neurochir (Wien) 149(10):999–1006. doi: 10.1007/s00701-007-1253-7 CrossRefGoogle Scholar
  20. 20.
    Pollock BE, Cochran J, Natt N, Brown PD, Erickson D, Link MJ, Garces YI, Foote RL, Stafford SL, Schomberg PJ (2008) Gamma Knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys 70(5):1325–1329. doi: 10.1016/j.ijrobp.2007.08.018 PubMedCrossRefGoogle Scholar
  21. 21.
    Kobayashi T (2009) Long-term results of stereotactic Gamma Knife radiosurgery for pituitary adenomas. Specific strategies for different types of adenoma. Prog Neurol Surg 22:77–95. doi: 10.1159/000163384 PubMedCrossRefGoogle Scholar
  22. 22.
    Castro DG, Cecilio SA, Canteras MM (2010) Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety. Radiat Oncol 5:109. doi: 10.1186/1748-717X-5-109 PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Hayashi M, Chernov M, Tamura N, Nagai M, Yomo S, Ochiai T, Amano K, Izawa M, Hori T, Muragaki Y, Iseki H, Okada Y, Takakura K (2010) Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol 98(2):185–194. doi: 10.1007/s11060-010-0172-2 PubMedCrossRefGoogle Scholar
  24. 24.
    Gopalan R, Schlesinger D, Vance ML, Laws E, Sheehan J (2011) Long-term outcomes after Gamma Knife radiosurgery for patients with a nonfunctioning pituitary adenoma. Neurosurgery 69(2):284–293. doi: 10.1227/NEU.0b013e31821bc44e PubMedCrossRefGoogle Scholar
  25. 25.
    Iwata H, Sato K, Tatewaki K, Yokota N, Inoue M, Baba Y, Shibamoto Y (2011) Hypofractionated stereotactic radiotherapy with CyberKnife for nonfunctioning pituitary adenoma: high local control with low toxicity. Neuro Oncol 13(8):916–922. doi: 10.1093/neuonc/nor055 PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Park KJ, Kano H, Parry PV, Niranjan A, Flickinger JC, Lunsford LD, Kondziolka D (2011) Long-term outcomes after Gamma Knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery 69(6):1188–1199. doi: 10.1227/NEU.0b013e318222afed PubMedCrossRefGoogle Scholar
  27. 27.
    El-Shehaby AM, Reda WA, Tawadros SR, Abdel Karim KM (2012) Low-dose Gamma Knife surgery for nonfunctioning pituitary adenomas. J Neurosurg 117(Suppl):84–88. doi: 10.3171/2012.6.GKS12986 PubMedGoogle Scholar
  28. 28.
    Runge MJ, Maarouf M, Hunsche S, Kocher M, Ruge MI, El Majdoub F, Treuer H, Mueller RP, Voges J, Sturm V (2012) LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results. Strahlenther Onkol 188(4):319–325. doi: 10.1007/s00066-011-0052-5 PubMedCrossRefGoogle Scholar
  29. 29.
    Starke RM, Williams BJ, Jane JA Jr, Sheehan JP (2012) Gamma Knife surgery for patients with nonfunctioning pituitary macroadenomas: predictors of tumor control, neurological deficits, and hypopituitarism. J Neurosurg 117(1):129–135. doi: 10.3171/2012.4.JNS112250 PubMedCrossRefGoogle Scholar
  30. 30.
    Wilson PJ, De-Loyde KJ, Williams JR, Smee RI (2012) A single centre’s experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the linear accelerator (Linac). J Clin Neurosci 19(3):370–374. doi: 10.1016/j.jocn.2011.07.025 PubMedCrossRefGoogle Scholar
  31. 31.
    Sheehan JP, Starke RM, Mathieu D, Young B, Sneed P, Chiang V, Lee JYK, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos J, Lunsford LD (2013) Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119((2):446–456PubMedCrossRefGoogle Scholar
  32. 32.
    Izawa M, Hayashi M, Nakaya K, Satoh H, Ochiai T, Hori T, Takakura K (2000) Gamma Knife radiosurgery for pituitary adenomas. J Neurosurg 93(Suppl 3):19–22. doi: 10.3171/jns.2000.93 PubMedGoogle Scholar
  33. 33.
    Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws ER Jr (2000) Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg 93(5):738–742. doi: 10.3171/jns.2000.93.5.0738 PubMedCrossRefGoogle Scholar
  34. 34.
    Shin M, Kurita H, Sasaki T, Tago M, Morita A, Ueki K, Kirino T (2000) Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 93(Suppl 3):2–5. doi: 10.3171/jns.2000.93 PubMedGoogle Scholar
  35. 35.
    Hoybye C, Grenback E, Rahn T, Degerblad M, Thoren M, Hulting AL (2001) Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery. Neurosurgery 49((2):284–291PubMedCrossRefGoogle Scholar
  36. 36.
    Kobayashi T, Kida Y, Mori Y (2002) Gamma Knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg 97(5 Suppl):422–428. doi: 10.3171/jns.2002.97 PubMedGoogle Scholar
  37. 37.
    Laws ER, Reitmeyer M, Thapar K, Vance ML (2002) Cushing’s disease resulting from pituitary corticotrophic microadenoma. Treatment results from transsphenoidal microsurgery and gamma knife radiosurgery. Neurochirurgie 48(2–3):294–299Google Scholar
  38. 38.
    Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF (2002) Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg 97(3):525–530. doi: 10.3171/jns.2002.97.3.0525 PubMedCrossRefGoogle Scholar
  39. 39.
    Choi JY, Chang JH, Chang JW, Ha Y, Park YG, Chung SS (2003) Radiological and hormonal responses of functioning pituitary adenomas after Gamma Knife radiosurgery. Yonsei Med J 44(4):602–607PubMedGoogle Scholar
  40. 40.
    Witt TC (2003) Stereotactic radiosurgery for pituitary tumors. Neurosurg Focus 14(5):e10PubMedGoogle Scholar
  41. 41.
    Wong GK, Leung CH, Chiu KW, Ma R, Cockram CS, Lam MJ, Poon WS (2003) LINAC radiosurgery in recurrent Cushing’s disease after transsphenoidal surgery: a series of 5 cases. Minim Invasive Neurosurg 46(6):327–330. doi: 10.1055/s-2003-812497 PubMedCrossRefGoogle Scholar
  42. 42.
    Devin JK, Allen GS, Cmelak AJ, Duggan DM, Blevins LS (2004) The efficacy of linear accelerator radiosurgery in the management of patients with Cushing’s disease. Stereotact Funct Neurosurg 82(5–6):254–262. doi: 10.1159/000083476 PubMedCrossRefGoogle Scholar
  43. 43.
    Castinetti F, Nagai M, Dufour H, Kuhn JM, Morange I, Jaquet P, Conte-Devolx B, Regis J, Brue T (2007) Gamma Knife radiosurgery is a successful adjunctive treatment in Cushing’s disease. Eur J Endocrinol 156(1):91–98. doi: 10.1530/eje.1.02323 PubMedCrossRefGoogle Scholar
  44. 44.
    Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML (2007) Gamma Knife surgery for Cushing’s disease. J Neurosurg 106(6):980–987. doi: 10.3171/jns.2007.106.6.980 PubMedCrossRefGoogle Scholar
  45. 45.
    Petit JH, Biller BM, Yock TI, Swearingen B, Coen JJ, Chapman P, Ancukiewicz M, Bussiere M, Klibanski A, Loeffler JS (2008) Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas. J Clin Endocrinol Metab 93(2):393–399PubMedCrossRefGoogle Scholar
  46. 46.
    Pollock BE, Brown PD, Nippoldt TB, Young WF (2008) Pituitary tumor type affects the chance of biochemical remission after radiosurgery of hormone-secreting pituitary adenomas. Neurosurgery 62(6):1271–1276. doi: 10.1227/01.neu.0000333298.49436.0e PubMedCrossRefGoogle Scholar
  47. 47.
    Tinnel BA, Henderson MA, Witt TC, Fakiris AJ, Worth RM, Des Rosiers PM, Edmondson JW, Timmerman RD, Lo SS (2008) Endocrine response after gamma knife-based stereotactic radiosurgery for secretory pituitary adenoma. Stereotact Funct Neurosurg 86(5):292–296. doi: 10.1159/000151717 PubMedCrossRefGoogle Scholar
  48. 48.
    Castinetti F, Nagai M, Morange I, Dufour H, Caron P, Chanson P, Cortet-Rudelli C, Kuhn JM, Conte-Devolx B, Regis J, Brue T (2009) Long-term results of stereotactic radiosurgery in secretory pituitary adenomas. J Clin Endocrinol Metab 94(9):3400–3407. doi: 10.1210/jc.2008-2772 PubMedCrossRefGoogle Scholar
  49. 49.
    Wan H, Chihiro O, Yuan S (2009) MASEP Gamma Knife radiosurgery for secretory pituitary adenomas: experience in 347 consecutive cases. J Exp Clin Cancer Res 28:36. doi: 10.1186/1756-9966-28-36 PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML (2011) Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 114(2):303–309. doi: 10.3171/2010.5.JNS091635 PubMedCrossRefGoogle Scholar
  51. 51.
    Wein L, Dally M, Bach LA (2012) Stereotactic radiosurgery for treatment of Cushing disease: an Australian experience. Intern Med J 42(10):1153–1156. doi: 10.1111/j.1445-5994.2012.02903.x PubMedCrossRefGoogle Scholar
  52. 52.
    Grant RA, Whicker M, Lleva R, Knisely JP, Inzucchi SE, Chiang VL (2013) Efficacy and safety of higher dose stereotactic radiosurgery for functional pituitary adenomas: a preliminary report. World Neurosurg. doi: 10.1016/j.wneu.2013.01.127 Google Scholar
  53. 53.
    Melmed S (2006) Medical progress: acromegaly. N Engl J Med 355(24):2558–2573. doi: 10.1056/NEJMra062453 PubMedCrossRefGoogle Scholar
  54. 54.
    Zhang N, Pan L, Wang EM, Dai JZ, Wang BJ, Cai PW (2000) Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg 93(Suppl 3):6–9. doi: 10.3171/jns.2000.93 PubMedGoogle Scholar
  55. 55.
    Fukuoka S, Ito T, Takanashi M, Hojo A, Nakamura H (2001) Gamma Knife radiosurgery for growth hormone-secreting pituitary adenomas invading the cavernous sinus. Stereotact Funct Neurosurg 76(3–4):213–217PubMedCrossRefGoogle Scholar
  56. 56.
    Ikeda H, Jokura H, Yoshimoto T (2001) Transsphenoidal surgery and adjuvant Gamma Knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg 95(2):285–291. doi: 10.3171/jns.2001.95.2.0285 PubMedCrossRefGoogle Scholar
  57. 57.
    Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, Farabola M, Loli P, Beck-Peccoz P, Arosio M (2003) Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study. J Clin Endocrinol Metab 88(7):3105–3112PubMedCrossRefGoogle Scholar
  58. 58.
    Muramatsu J, Yoshida M, Shioura H, Kawamura Y, Ito H, Takeuchi H, Kubota T, Maruyama I (2003) Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma. Nihon Igaku Hoshasen Gakkai Zasshi 63(5):225–230PubMedGoogle Scholar
  59. 59.
    Castinetti F, Taieb D, Kuhn JM, Chanson P, Tamura M, Jaquet P, Conte-Devolx B, Regis J, Dufour H, Brue T (2005) Outcome of Gamma Knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab 90(8):4483–4488. doi: 10.1210/jc.2005-0311 PubMedCrossRefGoogle Scholar
  60. 60.
    Gutt B, Wowra B, Alexandrov R, Uhl E, Schaaf L, Stalla GK, Schopohl J (2005) Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes 113(4):219–224. doi: 10.1055/s-2005-837552 PubMedCrossRefGoogle Scholar
  61. 61.
    Kobayashi T, Mori Y, Uchiyama Y, Kida Y, Fujitani S (2005) Long-term results of Gamma Knife surgery for growth hormone-producing pituitary adenoma: is the disease difficult to cure? J Neurosurg 102:119–123PubMedCrossRefGoogle Scholar
  62. 62.
    Jezkova J, Marek J, Hana V, Krsek M, Weiss V, Vladyka V, Lisak R, Vymazal J, Pecen L (2006) Gamma Knife radiosurgery for acromegaly–long-term experience. Clin Endocrinol (Oxf) 64(5):588–595. doi: 10.1111/j.1365-2265.2006.02513.x CrossRefGoogle Scholar
  63. 63.
    Pollock BE, Jacob JT, Brown PD, Nippoldt TB (2007) Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg 106(5):833–838. doi: 10.3171/jns.2007.106.5.833 PubMedCrossRefGoogle Scholar
  64. 64.
    Roberts BK, Ouyang DL, Lad SP, Chang SD, Harsh GRT (2007) Efficacy and safety of CyberKnife radiosurgery for acromegaly. Pituitary 10(1):19–25. doi: 10.1007/s11102-007-0004-3 PubMedCrossRefGoogle Scholar
  65. 65.
    Vik-Mo EO, Oksnes M, Pedersen PH, Wentzel-Larsen T, Rodahl E, Thorsen F, Schreiner T, Aanderud S, Lund-Johansen M (2007) Gamma Knife stereotactic radiosurgery for acromegaly. Eur J Endocrinol 157(3):255–263. doi: 10.1530/EJE-07-0189 PubMedCrossRefGoogle Scholar
  66. 66.
    Jagannathan J, Sheehan JP, Pouratian N, Laws ER Jr, Steiner L, Vance ML Jr (2008) Gamma Knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery 62:1262–1269. doi: 10.1227/01.neu.0000333297.41813.3d PubMedCrossRefGoogle Scholar
  67. 67.
    Losa M, Gioia L, Picozzi P, Franzin A, Valle M, Giovanelli M, Mortini P (2008) The role of stereotactic radiotherapy in patients with growth hormone-secreting pituitary adenoma. J Clin Endocrinol Metab 93(7):2546–2552. doi: 10.1210/jc.2008-0135 PubMedCrossRefGoogle Scholar
  68. 68.
    Ronchi CL, Attanasio R, Verrua E, Cozzi R, Ferrante E, Loli P, Montefusco L, Motti E, Ferrari DI, Giugni E, Beck-Peccoz P, Arosio M (2009) Efficacy and tolerability of Gamma Knife radiosurgery in acromegaly: a 10-year follow-up study. Clin Endocrinol (Oxf) 71(6):846–852. doi: 10.1111/j.1365-2265.2009.03589.x CrossRefGoogle Scholar
  69. 69.
    Iwai Y, Yamanaka K, Yoshimura M, Kawasaki I, Yamagami K, Yoshioka K (2010) Gamma Knife radiosurgery for growth hormone-producing adenomas. J Clin Neurosci 17(3):299–304. doi: 10.1016/j.jocn.2009.05.040 PubMedCrossRefGoogle Scholar
  70. 70.
    Poon TL, Leung SC, Poon CY, Yu CP (2010) Predictors of outcome following Gamma Knife surgery for acromegaly. J Neurosurg 113(Suppl):149–152PubMedGoogle Scholar
  71. 71.
    Franzin A, Spatola G, Losa M, Picozzi P, Mortini P (2012) Results of Gamma Knife radiosurgery in acromegaly. Int J Endocrinol 2012:342034. doi: 10.1155/2012/342034 PubMedCentralPubMedCrossRefGoogle Scholar
  72. 72.
    Liu X, Kano H, Kondziolka D, Park KJ, Iyer A, Niranjan A, Flickinger JC, Lunsford LD (2012) Gamma Knife radiosurgery for clinically persistent acromegaly. J Neurooncol 109(1):71–79. doi: 10.1007/s11060-012-0862-z PubMedCrossRefGoogle Scholar
  73. 73.
    Liu X, Kano H, Kondziolka D, Park KJ, Iyer A, Shin S, Niranjan A, Flickinger JC, Lunsford LD (2013) Gamma Knife stereotactic radiosurgery for drug resistant or intolerant invasive prolactinomas. Pituitary 16(1):68–75. doi: 10.1007/s11102-012-0376-x PubMedCrossRefGoogle Scholar
  74. 74.
    Landolt AM, Lomax N (2000) Gamma Knife radiosurgery for prolactinomas. J Neurosurg 93(Suppl 3):14–18. doi: 10.3171/jns.2000.93 PubMedGoogle Scholar
  75. 75.
    Pan L, Zhang N, Wang EM, Wang BJ, Dai JZ, Cai PW (2000) Gamma Knife radiosurgery as a primary treatment for prolactinomas. J Neurosurg 93(Suppl 3):10–13. doi: 10.3171/jns.2000.93 PubMedGoogle Scholar
  76. 76.
    Pouratian N, Sheehan J, Jagannathan J, Laws ER Jr, Steiner L, Vance ML (2006) Gamma Knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 59(2):255–266. doi: 10.1227/01.NEU.0000223445.22938.BD PubMedCrossRefGoogle Scholar
  77. 77.
    Jezkova J, Hana V, Krsek M, Weiss V, Vladyka V, Liscak R, Vymazal J, Pecen L, Marek J (2009) Use of the Leksell Gamma Knife in the treatment of prolactinoma patients. Clin Endocrinol (Oxf) 70(5):732–741. doi: 10.1111/j.1365-2265.2008.03384.x CrossRefGoogle Scholar
  78. 78.
    Tanaka S, Link MJ, Brown PD, Stafford SL, Young WF Jr, Pollock BE (2010) Gamma Knife radiosurgery for patients with prolactin-secreting pituitary adenomas. World Neurosurg 74(1):147–152. doi: 10.1016/j.wneu.2010.05.007 PubMedCrossRefGoogle Scholar
  79. 79.
    Levy RP, Fabrikant JI, Frankel KA, Phillips MH, Lyman JT, Lawrence JH, Tobias CA (1991) Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Funct Neurosurg 57(1–2):22–35PubMedCrossRefGoogle Scholar
  80. 80.
    Ganz JC, Backlund EO, Thorsen FA (1993) The effects of Gamma Knife surgery of pituitary adenomas on tumor growth and endocrinopathies. Stereotact Funct Neurosurg 61(Suppl 1):30–37PubMedGoogle Scholar
  81. 81.
    Wolffenbuttel BH, Kitz K, Beuls EM (1998) Beneficial gamma-knife radiosurgery in a patient with Nelson’s syndrome. Clin Neurol Neurosurg 100(1):60–63PubMedCrossRefGoogle Scholar
  82. 82.
    Laws ER Jr, Vance ML (1999) Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am 10(2):327–336PubMedGoogle Scholar
  83. 83.
    Mauermann WJ, Sheehan JP, Chernavvsky DR, Laws ER, Steiner L, Vance ML (2007) Gamma Knife surgery for adrenocorticotropic hormone-producing pituitary adenomas after bilateral adrenalectomy. J Neurosurg 106(6):988–993. doi: 10.3171/jns.2007.106.6.988 PubMedCrossRefGoogle Scholar
  84. 84.
    Jagannathan J, Yen CP, Pouratian N, Laws ER, Sheehan JP (2009) Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the gamma knife. J Neurooncol 92(3):345–356. doi: 10.1007/s11060-009-9832-5 PubMedCrossRefGoogle Scholar
  85. 85.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (2000) Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 85(3):1287–1289PubMedCrossRefGoogle Scholar
  86. 86.
    Cifarelli CP, Schlesinger DJ, Sheehan JP (2012) Cranial nerve dysfunction following Gamma Knife surgery for pituitary adenomas: long-term incidence and risk factors. J Neurosurg 116(6):1304–1310. doi: 10.3171/2012.2.JNS111630 PubMedCrossRefGoogle Scholar
  87. 87.
    Lim YJ, Leem W, Park JT, Kim TS, Rhee BA, Kim GK (1999) Cerebral infarction with ICA occlusion after Gamma Knife radiosurgery for pituitary adenoma: a case report. Stereotact Funct Neurosurg 72(Suppl 1):132–139PubMedCrossRefGoogle Scholar
  88. 88.
    Loeffler JS, Niemierko A, Chapman PH (2003) Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 52(6):1436–1440PubMedCrossRefGoogle Scholar
  89. 89.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (1998) Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 88(6):1002–1008. doi: 10.3171/jns.1998.88.6.1002 PubMedCrossRefGoogle Scholar
  90. 90.
    Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M (1995) External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33(2):307–314. doi: 10.1016/0360-3016(95)00071-6 PubMedCrossRefGoogle Scholar
  91. 91.
    Becker G, Kocher M, Kortmann RD, Paulsen F, Jeremic B, Muller RP, Bamberg M (2002) Radiation therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol 178(4):173–186PubMedCrossRefGoogle Scholar
  92. 92.
    Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122. doi: 10.1016/0360-3016(91)90171-y PubMedCrossRefGoogle Scholar
  93. 93.
    Brada M, Burchell L, Ashley S, Traish D (1999) The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys 45(3):693–698PubMedCrossRefGoogle Scholar
  94. 94.
    Mitsumori M, Shrieve DC, Alexander E 3rd, Kaiser UB, Richardson GE, Black PM, Loeffler JS (1998) Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys 42(3):573–580PubMedCrossRefGoogle Scholar
  95. 95.
    Estrada J, Boronat M, Mielgo M, Magallon R, Millan I, Diez S, Lucas T, Barcelo B (1997) The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med 336(3):172–177. doi: 10.1056/NEJM199701163360303 PubMedCrossRefGoogle Scholar
  96. 96.
    Minniti G, Osti M, Jaffrain-Rea ML, Esposito V, Cantore G, Maurizi Enrici R (2007) Long-term follow-up results of postoperative radiation therapy for Cushing’s disease. J Neurooncol 84(1):79–84. doi: 10.1007/s11060-007-9344-0 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Dale Ding
    • 1
  • Robert M. Starke
    • 1
  • Jason P. Sheehan
    • 1
  1. 1.Department of Neurological SurgeryUniversity of VirginiaCharlottesvilleUSA

Personalised recommendations