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Long-term results of hypofractionated stereotactic radiotherapy with CyberKnife for growth hormone-secreting pituitary adenoma: evaluation by the Cortina consensus

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Abstract

The aim of the present study was to evaluate the safety and feasibility of hypofractionated stereotactic radiotherapy (SRT) with CyberKnife for growth hormone-secreting pituitary adenoma (GH-PA). Fifty-two patients with GH-PA were treated with hypofractionated SRT between September 2001 and October 2012. Eight patients had clinically silent GH-PA and 44 were symptomatic. Only 1 patient was inoperable. The other patients had recurrent or postoperative residual tumors on MRI. All patients had received pharmacotherapy prior to SRT with a somatostatin analog, dopamine agonist, and/or GH receptor antagonist. The marginal doses were 17.4–26.8 Gy for the 3-fraction schedule and 20.0–32.0 Gy for the 5-fraction schedule. Endocrinological remission was assessed by the Cortina consensus criteria 2010 (random GH <1 ng/ml or nadir GH after an oral glucose tolerance test <0.4 ng/ml and normalization of age- and sex-adjusted insulin-like growth factor-1). The median follow-up period was 60 months (range 27–137). The 5-year overall survival, local control, and disease-free survival rates were 100, 100, and 96 %, respectively. Nine patients (5 clinically silent and 4 symptomatic patients) satisfied the Cortina criteria without receiving further pharmacotherapy, whereas the remaining 43 patients did not. No post-SRT grade 2 or higher visual disorder occurred. Symptomatic post-SRT hypopituitarism was observed in 1 patient. CyberKnife hypofractionated SRT is safe and effective when judged by imaging findings for GH-PA. However, it may be difficult to satisfy the Cortina consensus criteria in most symptomatic patients with SRT alone. Further investigations of optimal treatments are warranted.

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Acknowledgments

The authors are grateful to Mr. Kosaku Inada, Mr. Manabu Senda, Mr. Kohei Okawa, and Ms. Kumiko Ogawa for their valuable help in this research.

Financial disclosure

The authors declare that they are not involved in any relationships with companies or organizations that make products related to this study.

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Authors and Affiliations

  1. Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan

    Hiromitsu Iwata

  2. Department of Neurosurgery, Yokohama CyberKnife Center, Yokohama, Japan

    Hiromitsu Iwata, Naoki Yokota & Seiji Ohta

  3. Department of Neurosurgery, CyberKnife Center, Japanese Red Cross Medical Center, Tokyo, Japan

    Kengo Sato, Ryutaro Nomura, Yusuke Tabei & Ichiro Suzuki

  4. Radiation Oncology Center, Suzukake Central Hospital, Hamamatsu, Japan

    Naoki Yokota

  5. Division of Quality Management with Radiotherapy, Yokohama CyberKnife Center, Yokohama, Japan

    Mitsuhiro Inoue

  6. Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan

    Shozo Yamada

  7. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Yuta Shibamoto

Authors
  1. Hiromitsu Iwata
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  2. Kengo Sato
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  3. Ryutaro Nomura
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  4. Yusuke Tabei
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  5. Ichiro Suzuki
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  6. Naoki Yokota
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  7. Mitsuhiro Inoue
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  8. Seiji Ohta
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  9. Shozo Yamada
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  10. Yuta Shibamoto
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Correspondence to Hiromitsu Iwata.

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No conflicts of interest exist for any of the authors.

Ethical standards

The study was conducted in accordance with the Declaration of Helsinki and complies with the current laws of the countries in which it was performed. An independent ethics committee or institutional review board for each study site approved the study protocol. Informed consent was obtained from all individual patients included in the study.

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Iwata, H., Sato, K., Nomura, R. et al. Long-term results of hypofractionated stereotactic radiotherapy with CyberKnife for growth hormone-secreting pituitary adenoma: evaluation by the Cortina consensus. J Neurooncol 128, 267–275 (2016). https://doi.org/10.1007/s11060-016-2105-1

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