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The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases

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Abstract

Purpose

This study evaluates the role and outcomes of Gamma Knife radiosurgery (GKRS) in the management of pituitary metastases.

Methods

The records of brain metastases patients who underwent GKRS at the University of Pittsburgh Medical Center during the 10-year interval of 2010–2020 were systematically reviewed. Outcome measures included patient survival, tumor control rate, pituitary hormonal outcomes, visual outcomes, adverse radiation effects (AREs), and need for adjuvant therapy.

Results

Eighteen patients with pituitary metastases (eight male; median age of 65.5 years) had sufficient clinical follow-up for analysis. The most common primary cancers were non-small cell lung cancer (n = 6) and breast cancer (n = 4). Patients presented with headache (n = 9) and visual difficulties (n = 6). One patient underwent resection before GKRS. The median tumor volume was 0.78 cc (range 0.04–6.42 cc). The median overall survival after GKRS was 6.5 months (range 0.5–58 months). The overall survival after GKRS at 3-, 6-, and 12-months were 72.2%, 50.0% and 38.9%, respectively. The tumor control rate was 94.4%. One patient had further progression that required additional GKRS. None of the patients developed AREs after GKRS.

Conclusion

GKRS is an effective treatment modality for the multidisciplinary management of patients with pituitary metastases. This minimally-invasive strategy is associated with optimal tumor control rate and low risk to adjacent optic nerves or neurovascular structures.

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Data availability

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

Code availability

Not applicable.

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Acknowledgements

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-200, Pittsburgh, PA, 15213, USA

    Zhishuo Wei, Sila Yavan, Hansen Deng, Arka N. Mallela, Zachary C. Gersey, Ajay Niranjan, L. Dade Lunsford & Hussam Abou-Al-Shaar

  2. Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Rimsha K. Shariff

  3. Division of Endocrinology and Metabolism, Neuroendocrinology Unit, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Rimsha K. Shariff & Pouneh K. Fazeli

Authors
  1. Zhishuo Wei
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  2. Sila Yavan
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  3. Hansen Deng
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  4. Arka N. Mallela
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  5. Zachary C. Gersey
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  6. Rimsha K. Shariff
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  7. Pouneh K. Fazeli
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  8. Ajay Niranjan
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  9. L. Dade Lunsford
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  10. Hussam Abou-Al-Shaar
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Contributions

HAAS and LDL designed the study. Material preparation, data collection and analysis were performed by ZW and SY. The first draft of the manuscript was written by ZW and all authors critically revised previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hussam Abou-Al-Shaar.

Ethics declarations

Conflict of interest

Dr. Lunsford is a consultant for Insightec DSMB and has direct stock ownership in Elekta AB. All other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

The study was approved by the IRB at the University of Pittsburgh Medical Center.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Committee at the University of Pittsburgh Medical Center.

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Informed consent was obtained from all participants included in study.

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Wei, Z., Yavan, S., Deng, H. et al. The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases. Pituitary 25, 948–958 (2022). https://doi.org/10.1007/s11102-022-01279-z

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  • DOI: https://doi.org/10.1007/s11102-022-01279-z

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