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Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas: results from a 26-year experience

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Abstract

Objective

The aim of this study was to evaluate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for patients with nonfunctioning pituitary adenomas (NFPAs).

Design and methods

This was a single-center retrospective study. Eighty-one patients with NFPAs undergoing initial GKRS were enrolled. The median age was 44.9 years (range, 7.2–75.5 years). The median tumor volume was 2.3 cm3 (range, 0.1–31.3 cm3), and the median tumor margin dose was 13.0 Gy (range, 8–22 Gy).

Results

Tumor shrunk in 63 patients (77.8%), remained stable in 9 (11.1%), treatment failure in 9 (11.1%) during a median follow-up of 67.1 months (range, 11.5–263.9 months). The tumor control rates were 100%, 99%, 95%, and 84%, at 1, 3, 5, and 10 years, respectively. In multivariate analysis, tumor volume (≥4 cm3) and margin dose (<12 Gy) were associated with treatment failure (hazard ratio (HR) = 7.093, 95% confidence interval (CI) = 1.098–45.083, p = 0.040, and HR = 9.643, 95% CI = 1.108–83.927, p = 0.040, respectively). New apoplexy occurred in seven patients (8.6%) after GKRS with a median time of 39.9 months (range, 11.9–166.8 months). In multivariate analysis, tumor volume (≥10 cm3) was a significant risk factor (HR = 10.642, 95% CI = 2.121–53.398, p = 0.004). New hypopituitarism occurred in 14 patients (17.3%). No factors were associated with new hypopituitarism. Four patients (4.9%) developed new or worsening visual dysfunction. No new cranial neuropathy was noted.

Conclusions

In this study, initial GKRS can provide a high tumor control rate, as well as a low incidence rate of complications in NFPAs. GKRS may be an alternative initial treatment for selected NFPAs.

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Funding

This work was supported by National Key Research and Development Project (grant number: 2017YFC0113700); National Natural Science Foundation of China (grant number: 81800682); the Medical Science and Technology Research Fund Project of Guangdong (grants number: A2018443); the Medical and Health Project of Guangdong (grant number: 20181A011069).

Author contributions

J.Y., Y.L., X.L., T.Q., C.P., J.Z., S.L., Y.H., and M.H. collected and analyszed the data; J.Y. and Y.L. wrote the paper; J.Y. and Y.D. conceived and designed all the experiments; J.Y. and Y.D. directed this work and edited the paper; and all the authors agreed on the final paper.

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  1. These authors contributed equally: Jinxiu Yu, Yanli Li

Authors and Affiliations

  1. Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China

    Jinxiu Yu, Shunyao Liang, Minyi Huang, Yong He & Yinhui Deng

  2. Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China

    Yanli Li

  3. Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China

    Tingting Quan

  4. Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China

    Xi Li

  5. Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China

    Chao Peng

  6. Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China

    Jiamin Zeng

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Yu, J., Li, Y., Quan, T. et al. Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas: results from a 26-year experience. Endocrine 68, 399–410 (2020). https://doi.org/10.1007/s12020-020-02260-1

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