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Outcome of partially irradiated recurrent nonfunctioning pituitary macroadenoma by gamma knife radiosurgery

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background

Gamma knife treatment outcome of large pituitary tumors which are only partially irradiated secondary to immediate proximity to critical structures such as the optic apparatus have not been rigorously studied.

Materials and methods

From July 2003 to December 2013, there were 41 cases of recurrent or residual nonfunctioning pituitary macroadenoma partially treated with gamma knife radiosurgery (GKRS) because the adenoma obscured part of the optic apparatus on planning SRS MR imaging.

Results

The follow up period after GKRS was 92.3 ± 5.6 months. The percentage of tumor coverage with the full dose was 88.5 ± 0.7%. Five of 43 (11.6%) patients experienced a transient visional decrease and one patient experienced a permanent visual field defect. During the follow up, two patients underwent transphenoidal surgery and one patient had a craniotomy due to tumor progression. Seven patients (16.2%) developed cortisol and thyroxine deficiencies. In multiple variant analyses, transient visual decline was correlated to the tumor volume (> 3.5 cc), percentage of tumor coverage (< 90%), the distance from the optic apparatus to the pituitary stalk (> 15 mm) and percentage of tumor above the orbital apex (65%).

Conclusion

In the limited case of this cohort, we found that partially treated pituitary nonfunctioning macroadenoma yielded a high tumor control rate. However, visual decline as a result of tumor progression or radiation effect can occur in a minority of patients. The radiosurgical technique warrants further study to better define the long-term risk to benefit profile for its use in complex pituitary macroadenoma obscuring part of the optic apparatus.

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Data availability

All data generated or analyzed during this study are included in this published article and its additional files.

Abbreviations

GKRS:

Gamma knife radiosurgery

Gy:

Gray

MRI:

Magnetic resonance imaging

PACS:

Picture archiving and communications system

TOF:

Time of flight

TSR:

Transphenoid surgery

LH:

Luteinizing hormone

FSH:

Follicle-stimulating hormone

ACTH:

Adrenocorticotropic Hormone

IGF-1:

Insulin-like growth factor 1

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Acknowledgements

The authors would like to thanks all assistant and Biostatistics Task Force of Taichung Veterans General Hospital for their kind assistances in the manuscript preparation and statistical analysis.

Funding

The funding (TCVGH-1064903C and TCVGH-PU1068101) was received from Taichung Veterans General Hospital, Taichung, Taiwan.

Author information

Author notes

  1. Chiung-Chyi Shen and Weir-Chiang You have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, 40705, Taichung, Taiwan

    Chiung-Chyi Shen, Ming-Hsi Sun, Shinh-Dung Lee, Hsi-Kai Tsou, Yen-Ju Chen & Hung-Chuan Pan

  2. Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan

    Weir-Chiang You

  3. Institute of Biomedical Science, National Chung-Hsin University, Taichung, Taiwan

    Meei-Ling Sheu

  4. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Jason Sheehan

  5. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Hung-Chuan Pan

Authors
  1. Chiung-Chyi Shen
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  2. Weir-Chiang You
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Contributions

SCC and YMC collected the data and wrote the manuscript. SMH, LSD and THK collected the data of imaging and visual field for analysis. CYJ and SML helped in statistical analysis. SJ helped to design this study. PHC conducted the study design and collected the data and edited the manuscript.

Corresponding author

Correspondence to Hung-Chuan Pan.

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Conflict of interest

There was no conflict of interest.

Ethical approval

Approval by ethical committee of Taichung Veterans General Hospital is on record No. CG12718B.

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Shen, CC., You, WC., Sun, MH. et al. Outcome of partially irradiated recurrent nonfunctioning pituitary macroadenoma by gamma knife radiosurgery. J Neurooncol 139, 767–775 (2018). https://doi.org/10.1007/s11060-018-2925-2

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  • DOI: https://doi.org/10.1007/s11060-018-2925-2

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