, Volume 15, Issue 2, pp 135–145 | Cite as

Radiotherapy for prolactin-secreting pituitary tumors

  • Lawrence J. Sheplan Olsen
  • Lizbeth Robles Irizarry
  • Samuel T. Chao
  • Robert J. Weil
  • Amir H. Hamrahian
  • Betul Hatipoglu
  • John H. Suh


Review the medical and surgical management of patients with prolactinomas and provide an in-depth appraisal of the role of radiotherapy in the treatment of prolactinomas. A thorough review of the pertinent literature was carried out and relevant topics were identified. Topics covered in this comprehensive review include: indications for the use of radiotherapy, choice between conventional radiotherapy and stereotactic radiosurgery, as well as the benefits and potential complications associated with each modality. Due to the excellent response rates with medical management, and rapid symptom relief afforded by resection or debulking surgery in patients who do not respond or tolerate medical therapy, radiotherapy is reserved for patients who do not respond to dopamine agonists and surgery. Both external beam radiotherapy and stereotactic radiosurgery retain important roles in the treatment of refractory or recurrent prolactinomas. Choosing the optimal approach is crucial in maximizing tumor control outcomes and minimizing the risks associated with treatment. The primary determinants of optimal radiation approach are proximity of the tumor to the optic apparatus and tumor size, with radiosurgery being our recommended treatment of choice unless the tumor is larger than 3–4 cm or within 3 mm of the optic nerves, chiasm or tracts. Optimal multidisciplinary management requires the identification of appropriate candidates for radiotherapy in order to take full advantage of treatment options available for each patient.


Prolactinoma Radiotherapy Radiosurgery External beam Radiation Pituitary tumor 


  1. 1.
    Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65(2):265–273. doi: 10.1111/j.1365-2265.2006.02562.x CrossRefGoogle Scholar
  2. 2.
    Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(2):273–288. doi: 10.1210/jc.2010-1692 PubMedCrossRefGoogle Scholar
  3. 3.
    Klibanski A (2010) Clinical practice. Prolactinomas. N Engl J Med 362(13):1219–1226. doi: 10.1056/NEJMcp0912025 PubMedCrossRefGoogle Scholar
  4. 4.
    Colao A, Savastano S (2011) Medical treatment of prolactinomas. Nat Rev Endocrinol 7(5):267–278. doi: 10.1038/nrendo.2011.37 PubMedCrossRefGoogle Scholar
  5. 5.
    Melmed S (2002) The pituitary, 2nd edn. Blackwell Pub, MaldenGoogle Scholar
  6. 6.
    Vandeva S, Jaffrain-Rea ML, Daly AF, Tichomirowa M, Zacharieva S, Beckers A (2010) The genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 24(3):461–476. doi: 10.1016/j.beem.2010.03.001 PubMedCrossRefGoogle Scholar
  7. 7.
    Karthikeyan M, Arunakaran J, Balasubramanian K (2009) The effects of prolactin and corticosterone on insulin binding to rat Leydig cells. Reprod Biol 9(2):189–194PubMedGoogle Scholar
  8. 8.
    Huang WJ, Yeh JY, Kan SF, Chang LS, Wang PS (2001) Effects of hyperprolactinemia on testosterone production in rat Leydig cells. J Cell Biochem 80(3):313–320. doi: 10.1002/1097-4644(20010301)80:3<313:AID-JCB30>3.0.CO;2-E PubMedCrossRefGoogle Scholar
  9. 9.
    Vilar L, Freitas MC, Naves LA, Casulari LA, Azevedo M, Montenegro R Jr, Barros AI, Faria M, Nascimento GC, Lima JG, Nobrega LH, Cruz TP, Mota A, Ramos A, Violante A, Lamounier Filho A, Gadelha MR, Czepielewski MA, Glezer A, Bronstein MD (2008) Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients. J Endocrinol Invest 31(5):436–444PubMedGoogle Scholar
  10. 10.
    Colao A (2009) Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab 23(5):575–596. doi: 10.1016/j.beem.2009.05.003 PubMedCrossRefGoogle Scholar
  11. 11.
    Molitch ME, Elton RL, Blackwell RE, Caldwell B, Chang RJ, Jaffe R, Joplin G, Robbins RJ, Tyson J, Thorner MO (1985) Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study. J Clin Endocrinol Metab 60(4):698–705PubMedCrossRefGoogle Scholar
  12. 12.
    Bevan JS, Webster J, Burke CW, Scanlon MF (1992) Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 13(2):220–240PubMedGoogle Scholar
  13. 13.
    Verhelst J, Abs R, Maiter D, van den Bruel A, Vandeweghe M, Velkeniers B, Mockel J, Lamberigts G, Petrossians P, Coremans P, Mahler C, Stevenaert A, Verlooy J, Raftopoulos C, Beckers A (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84(7):2518–2522PubMedCrossRefGoogle Scholar
  14. 14.
    Barker FG 2nd, Klibanski A, Swearingen B (2003) Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 88(10):4709–4719PubMedCrossRefGoogle Scholar
  15. 15.
    Gittoes NJ, Sheppard MC, Johnson AP, Stewart PM (1999) Outcome of surgery for acromegaly—the experience of a dedicated pituitary surgeon. QJM 92(12):741–745PubMedCrossRefGoogle Scholar
  16. 16.
    Yamada S, Aiba T, Takada K, Ozawa Y, Shimizu T, Sawano S, Shishiba Y, Sano T (1996) Retrospective analysis of long-term surgical results in acromegaly: preoperative and postoperative factors predicting outcome. Clin Endocrinol (Oxf) 45(3):291–298CrossRefGoogle Scholar
  17. 17.
    Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF (2002) Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf) 56(4):541–551CrossRefGoogle Scholar
  18. 18.
    Swords FM, Monson JP, Besser GM, Chew SL, Drake WM, Grossman AB, Plowman PN (2009) Gamma knife radiosurgery: a safe and effective salvage treatment for pituitary tumours not controlled despite conventional radiotherapy. Eur J Endocrinol 161(6):819–828. doi: 10.1530/EJE-09-0493 PubMedCrossRefGoogle Scholar
  19. 19.
    Jenkins PJ, Bates P, Carson MN, Stewart PM, Wass JA (2006) Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly. J Clin Endocrinol Metab 91(4):1239–1245. doi: 10.1210/jc.2005-1616 PubMedCrossRefGoogle Scholar
  20. 20.
    Barrande G, Pittino-Lungo M, Coste J, Ponvert D, Bertagna X, Luton JP, Bertherat J (2000) Hormonal and metabolic effects of radiotherapy in acromegaly: long-term results in 128 patients followed in a single center. J Clin Endocrinol Metab 85(10):3779–3785PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    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
  23. 23.
    Witt TC (2003) Stereotactic radiosurgery for pituitary tumors. Neurosurg Focus 14(5):e10PubMedCrossRefGoogle Scholar
  24. 24.
    Kong DS, Lee JI, Lim do H, Kim KW, Shin HJ, Nam DH, Park K, Kim JH (2007) The efficacy of fractionated radiotherapy and stereotactic radiosurgery for pituitary adenomas: long-term results of 125 consecutive patients treated in a single institution. Cancer 110(4):854–860. doi: 10.1002/cncr.22860 PubMedCrossRefGoogle Scholar
  25. 25.
    Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27(5):485–534. doi: 10.1210/er.2005-9998 PubMedCrossRefGoogle Scholar
  26. 26.
    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 discussion 255-266PubMedCrossRefGoogle Scholar
  27. 27.
    Antunes J, Housepian J, Frantz E (1977) Prolactin-secreting pituitary tumors. Ann Neurol 2(2):148–153CrossRefGoogle Scholar
  28. 28.
    Gomez F, Reyes FI, Faiman C (1977) Nonpuerperal galactorrhea and hyperprolactinemia. Clinical findings, endocrine features and therapeutic responses in 56 cases. Am J Med 62(5):648–660PubMedCrossRefGoogle Scholar
  29. 29.
    Grossman A, Cohen BL, Charlesworth M, Plowman PN, Rees LH, Wass JA, Jones AE, Besser GM (1984) Treatment of prolactinomas with megavoltage radiotherapy. Br Med J (Clin Res Ed) 288(6424):1105–1109CrossRefGoogle Scholar
  30. 30.
    Johnston DG, Hall K, Kendall-Taylor P, Ross WM, Crombie AL, Cook DB, Watson MJ (1986) The long-term effects of megavoltage radiotherapy as sole or combined therapy for large prolactinomas: studies with high definition computerized tomography. Clin Endocrinol (Oxf) 24(6):675–685CrossRefGoogle Scholar
  31. 31.
    Wang C, Lam KS, Ma JT, Chan T, Liu MY, Yeung RT (1987) Long-term treatment of hyperprolactinaemia with bromocriptine: effect of drug withdrawal. Clin Endocrinol (Oxf) 27(3):363–371CrossRefGoogle Scholar
  32. 32.
    Mehta AE, Reyes FI, Faiman C (1987) Primary radiotherapy of prolactinomas. Eight- to 15-year follow-up. Am J Med 83(1):49–58PubMedCrossRefGoogle Scholar
  33. 33.
    Tsagarakis S, Grossman A, Plowman PN, Jones AE, Touzel R, Rees LH, Wass JA, Besser GM (1991) Megavoltage pituitary irradiation in the management of prolactinomas: long-term follow-up. Clin Endocrinol (Oxf) 34(5):399–406CrossRefGoogle Scholar
  34. 34.
    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
  35. 35.
    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
  36. 36.
    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):307–314PubMedCrossRefGoogle Scholar
  37. 37.
    Wallace EA, Holdaway IM (1995) Treatment of macroprolactinomas at Auckland Hospital 1975–91. N Z Med J 108(994):50–52PubMedGoogle Scholar
  38. 38.
    Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ (1996) Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol 41(1):45–53PubMedCrossRefGoogle Scholar
  39. 39.
    Lim YL, Leem W, Kim TS, Rhee BA, Kim GK (1998) Four years’ experiences in the treatment of pituitary adenomas with gamma knife radiosurgery. Stereotact Funct Neurosurg 70(Suppl 1):95–109PubMedCrossRefGoogle Scholar
  40. 40.
    Martinez R, Bravo G, Burzaco J, Rey G (1998) Pituitary tumors and gamma knife surgery. Clinical experience with more than two years of follow-up. Stereotact Funct Neurosurg 70(Suppl 1):110–118PubMedCrossRefGoogle Scholar
  41. 41.
    Morange-Ramos I, Regis J, Dufour H, Andrieu JM, Grisoli F, Jaquet P, Peragut JC (1998) Gamma-knife surgery for secreting pituitary adenomas. Acta Neurochir (Wien) 140(5):437–443CrossRefGoogle Scholar
  42. 42.
    Inoue HK, Kohga H, Hirato M, Sasaki T, Ishihara J, Shibazaki T, Ohye C, Andou Y (1999) Pituitary adenomas treated by microsurgery with or without Gamma Knife surgery: experience in 122 cases. Stereotact Funct Neurosurg 72(Suppl 1):125–131PubMedCrossRefGoogle Scholar
  43. 43.
    Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz JC, Pendl G (1999) A six year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg 72(Suppl 1):88–100PubMedCrossRefGoogle Scholar
  44. 44.
    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.supplement3.0019 PubMedGoogle Scholar
  45. 45.
    Landolt AM, Lomax N (2000) Gamma knife radiosurgery for prolactinomas. J Neurosurg 93(Suppl 3):14–18. doi: 10.3171/jns.2000.93.supplement3.0014 PubMedGoogle Scholar
  46. 46.
    Zhang N, Pan L, Dai J, Wang B, Wang E, Zhang W, Cai P (2000) Gamma Knife radiosurgery as a primary surgical treatment for hypersecreting pituitary adenomas. Stereotact Funct Neurosurg 75(2–3):123–128PubMedCrossRefGoogle Scholar
  47. 47.
    Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97(Suppl 5):415–421. doi: 10.3171/jns.2002.97.supplement5.0415 PubMedGoogle Scholar
  48. 48.
    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
  49. 49.
    Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML (2003) Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53(1): 51–59; discussion 59–61Google Scholar
  50. 50.
    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. Nippon Igaku Hoshasen Gakkai Zasshi 63(5):225–230PubMedGoogle Scholar
  51. 51.
    Kuo JS, Chen JC, Yu C, Zelman V, Giannotta SL, Petrovich Z, MacPherson D, Apuzzo ML (2004) Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54(6):1385–1393; discussion 1393–1384Google Scholar
  52. 52.
    Colin P, Jovenin N, Delemer B, Caron J, Grulet H, Hecart AC, Lukas C, Bazin A, Bernard MH, Scherpereel B, Peruzzi P, Nakib I, Redon C, Rousseaux P (2005) Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: a prospective study of 110 patients. Int J Radiat Oncol Biol Phys 62(2):333–341. doi: 10.1016/j.ijrobp.2004.09.058 PubMedCrossRefGoogle Scholar
  53. 53.
    Ma ZM, Qiu B, Hou YH, Liu YS (2006) Gamma knife treatment for pituitary prolactinomas. Zhong Nan Da Xue Xue Bao Yi Xue Ban 31(5):714–716PubMedGoogle Scholar
  54. 54.
    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
  55. 55.
    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
  56. 56.
    Sun DQ, Cheng JJ, Frazier JL, Batra S, Wand G, Kleinberg LR, Rigamonti D, Quinones-Hinojosa A, Salvatori R, Lim M (2010) Treatment of pituitary adenomas using radiosurgery and radiotherapy: a single center experience and review of literature. Neurosurg Rev 34(2):181–189. doi: 10.1007/s10143-010-0285-2 PubMedCrossRefGoogle Scholar
  57. 57.
    Schalin-Jantti C, Valanne L, Tenhunen M, Setala K, Paetau A, Sane T, Kouri M (2010) Outcome of fractionated stereotactic radiotherapy in patients with pituitary adenomas resistant to conventional treatments: a 5.25-year follow-up study. Clin Endocrinol (Oxf) 73(1):72–77. doi: 10.1111/j.1365-2265.2009.03755.x Google Scholar
  58. 58.
    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
  59. 59.
    McCord MW, Buatti JM, Fennell EM, Mendenhall WM, Marcus RB Jr, Rhoton AL, Grant MB, Friedman WA (1997) Radiotherapy for pituitary adenoma: long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 39(2):437–444PubMedCrossRefGoogle Scholar
  60. 60.
    Grabenbauer GG, Ernst-Stecken A, Schneider F, Lambrecht U, Ganslandt O (2006) Radiosurgery of functioning pituitary adenomas: comparison of different treatment techniques including dynamic and conformal arcs, shaped beams, and IMRT. Int J Radiat Oncol Biol Phys 66(Suppl 4):S33–S39CrossRefGoogle Scholar
  61. 61.
    Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA (1986) Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 81(3):457–462PubMedCrossRefGoogle Scholar
  62. 62.
    Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML (1989) Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 70(262):145–160PubMedGoogle Scholar
  63. 63.
    Parsons JT, Bova FJ, Fitzgerald CR, Mendenhall WM, Million RR (1994) Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 30(4):755–763PubMedCrossRefGoogle Scholar
  64. 64.
    Jiang GL, Tucker SL, Guttenberger R, Peters LJ, Morrison WH, Garden AS, Ha CS, Ang KK (1994) Radiation-induced injury to the visual pathway. Radiother Oncol 30(1):17–25PubMedCrossRefGoogle Scholar
  65. 65.
    Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001) Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet 357(9254):425–431PubMedCrossRefGoogle Scholar
  66. 66.
    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
  67. 67.
    Erridge SC, Conkey DS, Stockton D, Strachan MW, Statham PF, Whittle IR, Grant R, Kerr GR, Gregor A (2009) Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol 93(3):597–601. doi: 10.1016/j.radonc.2009.09.011 PubMedCrossRefGoogle Scholar
  68. 68.
    Shimizu Y, Kodama K, Nishi N, Kasagi F, Suyama A, Soda M, Grant EJ, Sugiyama H, Sakata R, Moriwaki H, Hayashi M, Konda M, Shore RE (2010) Radiation exposure and circulatory disease risk: Hiroshima and Nagasaki atomic bomb survivor data, 1950–2003. BMJ 340:b5349PubMedCrossRefGoogle Scholar
  69. 69.
    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(2):800–804. doi: 10.1210/jc.2004-1152 PubMedCrossRefGoogle Scholar
  70. 70.
    Mackley HB, Reddy CA, Lee SY, Harnisch GA, Mayberg MR, Hamrahian AH, Suh JH (2007) Intensity-modulated radiotherapy for pituitary adenomas: the preliminary report of the Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 67(1):232–239. doi: 10.1016/j.ijrobp.2006.08.039 PubMedCrossRefGoogle Scholar
  71. 71.
    Stafford SL, Pollock BE, Leavitt JA, Foote RL, Brown PD, Link MJ, Gorman DA, Schomberg PJ (2003) A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 55(5):1177–1181PubMedCrossRefGoogle Scholar
  72. 72.
    Akamatsu Y, Murakami K, Watanabe M, Jokura H, Tominaga T (2010) Malignant peripheral nerve sheath tumor arising from benign vestibular schwannoma treated by gamma knife radiosurgery after two previous surgeries: a case report with surgical and pathological observations. World Neurosurg 73(6):751–754. doi: 10.1016/j.wneu.2010.04.009 PubMedCrossRefGoogle Scholar
  73. 73.
    Berman EL, Eade TN, Brown D, Weaver M, Glass J, Zorman G, Feigenberg SJ (2007) Radiation-induced tumor after stereotactic radiosurgery for an arteriovenous malformation: case report. Neurosurgery 61(5):E1099. doi: 10.1227/01.neu.0000303207.92617.4e. discussion E1099PubMedCrossRefGoogle Scholar
  74. 74.
    Comey CH, McLaughlin MR, Jho HD, Martinez AJ, Lunsford LD (1998) Death from a malignant cerebellopontine angle triton tumor despite stereotactic radiosurgery. Case report. J Neurosurg 89(4):653–658. doi: 10.3171/jns.1998.89.4.0653 PubMedCrossRefGoogle Scholar
  75. 75.
    Kaido T, Hoshida T, Uranishi R, Akita N, Kotani A, Nishi N, Sakaki T (2001) Radiosurgery-induced brain tumor. Case report. J Neurosurg 95(4):710–713. doi: 10.3171/jns.2001.95.4.0710 PubMedCrossRefGoogle Scholar
  76. 76.
    McIver JI, Pollock BE (2004) Radiation-induced tumor after stereotactic radiosurgery and whole brain radiotherapy: case report and literature review. J Neurooncol 66(3):301–305PubMedCrossRefGoogle Scholar
  77. 77.
    Sasagawa Y, Akai T, Itou S, Iizuka H (2009) Gamma knife radiosurgery-induced cavernous hemangioma: case report. Neurosurgery 64(5):E1006–E1007. doi: 10.1227/01.NEU.0000344005.23146.CC discussion E1007PubMedCrossRefGoogle Scholar
  78. 78.
    Shamisa A, Bance M, Nag S, Tator C, Wong S, Noren G, Guha A (2001) Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. J Neurosurg 94(5):816–821. doi: 10.3171/jns.2001.94.5.0816 PubMedCrossRefGoogle Scholar
  79. 79.
    Sheehan J, Yen CP, Steiner L (2006) Gamma knife surgery-induced meningioma. Report of two cases and review of the literature. J Neurosurg 105(2):325–329. doi: 10.3171/jns.2006.105.2.325 PubMedCrossRefGoogle Scholar
  80. 80.
    Shin M, Ueki K, Kurita H, Kirino T (2002) Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery. Lancet 360(9329):309–310. doi: 10.1016/S0140-6736(02)09521-1 PubMedCrossRefGoogle Scholar
  81. 81.
    Yu JS, Yong WH, Wilson D, Black KL (2000) Glioblastoma induction after radiosurgery for meningioma. Lancet 356(9241):1576–1577. doi: 10.1016/S0140-6736(00)03134-2 PubMedCrossRefGoogle Scholar
  82. 82.
    Cahan WG, Woodard HQ et al (1948) Sarcoma arising in irradiated bone; report of 11 cases. Cancer 1(1):3–29PubMedCrossRefGoogle Scholar
  83. 83.
    Grattan-Smith PJ, Morris JG, Shores EA, Batchelor J, Sparks RS (1992) Neuropsychological abnormalities in patients with pituitary tumours. Acta Neurol Scand 86(6):626–631PubMedCrossRefGoogle Scholar
  84. 84.
    Peace KA, Orme SM, Thompson AR, Padayatty S, Ellis AW, Belchetz PE (1997) Cognitive dysfunction in patients treated for pituitary tumours. J Clin Exp Neuropsychol 19(1):1–6PubMedCrossRefGoogle Scholar
  85. 85.
    Gondi V, Tome WA, Mehta MP (2010) Why avoid the hippocampus? A comprehensive review. Radiother Oncol 97(3):370–376. doi: 10.1016/j.radonc.2010.09.013 PubMedCrossRefGoogle Scholar
  86. 86.
    Mahajan A, Dong L, Prabhu S, Wang C, Zhang Y, Lifei Z, Meyers C, Woo S (2007) Application of deformable image registration to hippocampal doses and neurocognitive outcomes. Soc Neuro Oncol 9:583Google Scholar
  87. 87.
    Mehta M (2011) RTOG 0933: a phase II trial of hippocampal avoidance during whole brain radiotherapy for brain metastases.
  88. 88.
    Guinan EM, Lowy C, Stanhope N, Lewis PD, Kopelman MD (1998) Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients. J Neurol Neurosurg Psychiatry 65(6):870–876PubMedCrossRefGoogle Scholar
  89. 89.
    Armstrong CL, Hunter JV, Ledakis GE, Cohen B, Tallent EM, Goldstein BH, Tochner Z, Lustig R, Judy KD, Pruitt A, Mollman JE, Stanczak EM, Jo MY, Than TL, Phillips P (2002) Late cognitive and radiographic changes related to radiotherapy: initial prospective findings. Neurology 59(1):40–48PubMedCrossRefGoogle Scholar
  90. 90.
    Brell M, Villa S, Teixidor P, Lucas A, Ferran E, Marin S, Acebes JJ (2006) Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance. Surg Neurol 65(1):28–33. doi: 10.1016/j.surneu.2005.06.027. discussion 33-24PubMedCrossRefGoogle Scholar
  91. 91.
    Maguire PD, Clough R, Friedman AH, Halperin EC (1999) Fractionated external-beam radiation therapy for meningiomas of the cavernous sinus. Int J Radiat Oncol Biol Phys 44(1):75–79PubMedCrossRefGoogle Scholar
  92. 92.
    Metellus P, Regis J, Muracciole X, Fuentes S, Dufour H, Nanni I, Chinot O, Martin PM, Grisoli F (2005) Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57(5):873–886. discussion 873-886PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Lawrence J. Sheplan Olsen
    • 1
  • Lizbeth Robles Irizarry
    • 2
  • Samuel T. Chao
    • 1
  • Robert J. Weil
    • 3
  • Amir H. Hamrahian
    • 4
  • Betul Hatipoglu
    • 4
  • John H. Suh
    • 1
  1. 1.Department of Radiation OncologyCleveland ClinicClevelandUSA
  2. 2.Department of Neuro-OncologyCleveland ClinicClevelandUSA
  3. 3.Department of NeurosurgeryCleveland ClinicClevelandUSA
  4. 4.Department of EndocrinologyCleveland ClinicClevelandUSA

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