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Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis

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Abstract

Purpose

Gamma Knife radiosurgery (GKRS) is feasible for pituitary adenomas, but post-surgery GKRS may cause severe hormone deficits. We reviewed the literature on primary GKRS for pituitary adenoma focusing on radiation-induced hormone deficiencies.

Methods

PubMed, Web-of-Science, Scopus, and Cochrane were searched upon the PRISMA guidelines to include studies describing primary GKRS for pituitary adenomas. Pooled-rates of GKRS-induced hormone deficiencies and clinical-radiological responses were analyzed with a random-effect model meta-analysis.

Results

We included 24 studies comprising 1381 patients. Prolactinomas were the most common (34.2%), and 289 patients had non-functioning adenomas (20.9%). Median tumor volume was 1.6cm3 (range, 0.01–31.3), with suprasellar extension and cavernous sinus invasion detected in 26% and 31.1% cases. GKRS was delivered with median marginal dose 22.6 Gy (range, 6–49), maximum dose 50 Gy (range, 25–90), and isodose line 50% (range, 9–100%). Median maximum point doses were 9 Gy (range, 0.5–25) to the pituitary stalk, 7 Gy (range, 1–38) to the optic apparatus, and 5 Gy (range, 0.4–12.3) to the optic chiasm. Pooled 5 year rates of endocrine normalization and local tumor control were 48% (95%CI 45–51%) and 97% (95%CI 95–98%). 158 patients (11.4%) experienced endocrinopathies at a median of 45 months (range, 4–187.3) after GKRS, with pooled 5-year rates of 8% (95%CI 6–9%). GKRS-induced hormone deficiencies comprised secondary hypothyroidism (42.4%) and hypogonadotropic hypogonadism (33.5%), with panhypopituitarism reported in 31 cases (19.6%).

Conclusion

Primary GKRS for pituitary adenoma may correlate with lower rates of radiation-induced hypopituitarism (11.4%) than post-surgery GKRS (18–32%). Minimal doses to normal pituitary structures and long-term endocrine follow-up are of primary importance.

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Data availability

All authors confirm the appropriateness of all dataset and software used for supporting the conclusion.

Code availability

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Authors and Affiliations

  1. Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA

    Paolo Palmisciano

  2. John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI, USA

    Christian Ogasawara

  3. University of California, Berkeley, CA, USA

    Maya Ogasawara

  4. Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy

    Gianluca Ferini

  5. Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, Catania, Italy

    Gianluca Scalia

  6. Texas A&M University College of Medicine, Houston, TX, USA

    Ali S. Haider

  7. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Othman Bin Alamer

  8. Department of Neurosurgery, IRCCS, Sapienza University of Rome, NeuromedPozzilli, Italy

    Maurizio Salvati

  9. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy

    Giuseppe E. Umana

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All authors contributed to the study conception and design. The study was conceptualized and supervised by G.E.U. and P.P. Material preparation, data collection and analysis were performed by P.P., C.O., M.O., G.F., G.S., A.S.H., O.B.A., and M.S. The first draft of the manuscript was written by P.P. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Palmisciano, P., Ogasawara, C., Ogasawara, M. et al. Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis. Pituitary 25, 404–419 (2022). https://doi.org/10.1007/s11102-022-01219-x

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