Abstract
Purpose
Metastases should be considered in a patient with a cancer history and a sellar/suprasellar lesion, as this diagnosis can change the management strategy in such patients. Once the diagnosis is established, stereotactic radiosurgery (SRS) can be a safe and effective approach for these patients.
Methods
This case series describes five patients with pituitary metastases managed with GKRS at a single institution, taken from our prospective registry. All patients had SRS using the Gamma Knife Perfexion or Icon (Elekta), according to our standard institutional protocol. The optic nerves and chiasm were contoured, and the plan was adjusted to restrict dose to the optic apparatus as necessary. The tumor margin doses delivered were 11 Gy, 12 Gy, 14 Gy, 18 Gy (3 sessions of 6 Gy), and 12 Gy at the 50% isodose line.
Results
In this series, all sellar metastases were treated successfully with good radiographic and clinical response. The histology of the tumors included endometrial, gastrointestinal, and lung adenocarcinomas. Typically, histology is taken into consideration when choosing the treatment dose, along with size and location. In these patients, however, the dose used for the sellar metastases was chosen primarily for visual safety. This was typically lower than the dose for brain metastases in other locations.
Conclusion
SRS provides an alternative treatment approach for sellar/suprasellar metastases with excellent local control, symptom improvement and maintenance of systemic therapy as desired. As such, CNS failure is rarely the proximate cause of demise in pituitary metastases provided that endocrinopathies are recognized and managed appropriately.
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References
Atallah-Yunes SA, Clark J, Samanani S, Soe M (2019) Small cell lung cancer with pituitary metastasis presenting as secondary adrenal insufficiency: a case report and literature review. Am J Case Rep 20:207–211. https://doi.org/10.12659/ajcr.913388
Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J (2018) Twelve cases of pituitary metastasis: a case series and review of the literature. Pituitary 21(5):463–473. https://doi.org/10.1007/s11102-018-0899-x
Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD (2019) Stereotactic radiosurgery for pituitary metastases. Surg Neurol 72(3):248–255. https://doi.org/10.1016/j.surneu.2008.06.003
Komninos J, Vlassopoulou V, Protopapa D, Korfias S, Kontogeorgos G, Sakas DE et al (2004) Tumors metastatic to the pituitary gland: case report and literature review. J Clin Endocrinol Metab 89(2):574–580. https://doi.org/10.1210/jc.2003-030395
Morita A, Meyer FB, Laws ER Jr (1998) Symptomatic pituitary metastases. J Neurosurg 89(1):69–73. https://doi.org/10.3171/jns.1998.89.1.0069
McCormick PC, Post KD, Kandji AD, Hays AP (1989) Metastatic carcinoma to the pituitary gland. Br J Neurosurg 3(1):71–79
Cai H, Liu W, Feng T, Li Z, Liu Y (2019) Clinical presentation and pathologic characteristics of pituitary metastasis from breast carcinoma: cases and a systematic review of the literature. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.12.126
Schubiger O, Haller D (1992) Metastases to the pituitary–hypothalamic axis. An MR study of 7 symptomatic patients. Neuroradiology 34(2):131–134
Ravindran K, Zsigray BM, Wemhoff MP, Spencer JD, Borys E, Patel CR et al (2019) Sellar metastasis of cervical adenocarcinoma. Case Rep Neurol Med 2019:9769657. https://doi.org/10.1155/2019/9769657
Branch CL Jr, Laws ER Jr (1987) Metastatic tumors of the sella turcica masquerading as primary pituitary tumors. J Clin Endocrinol Metab 65(3):469–474. https://doi.org/10.1210/jcem-65-3-469
Mori Y, Kobayashi T, Shibamoto Y (2006) Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus. J Neurosurg 105(Suppl):37–42. https://doi.org/10.3171/sup.2006.105.7.37
Piedra MP, Brown PD, Carpenter PC, Link MJ (2004) Resolution of diabetes insipidus following gamma knife surgery for a solitary metastasis to the pituitary stalk: case report. J Neurosurg 101(6):1053–1056. https://doi.org/10.3171/jns.2004.101.6.1053
Chon H, Yoon K, Kwon DH, Kim CJ, Kim MS, Cho YH (2017) Hypofractionated stereotactic radiosurgery for pituitary metastases. J Neurooncol 132(1):127–133. https://doi.org/10.1007/s11060-016-2346-z
Lithgow K, Siqueira I, Senthil L et al (2020) Pituitary metastases: presentation and outcomes from a pituitary center over the last decade. Pituitary 15:242–245
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Benjamin, C., Ashayeri, K., Golfinos, J.G. et al. Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer. Pituitary 23, 665–671 (2020). https://doi.org/10.1007/s11102-020-01074-8
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DOI: https://doi.org/10.1007/s11102-020-01074-8