Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas

A multicenter study

Jason P. Sheehan, Robert M. Starke, David Mathieu, Byron Young, Penny K. Sneed, Veronica L. Chiang, John Y.K. Lee, Hideyuki Kano, Kyung-Jae Park, Ajay Niranjan, Douglas Kondziolka, Gene H. Barnett, Stephen Rush, John G. Golfinos, L. Dade Lunsford

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Object. Pituitary adenomas are fairly common intracranial neoplasms, and nonfunctioning ones constitute a large subgroup of these adenomas. Complete resection is often difficult and may pose undue risk to neurological and endocrine function. Stereotactic radiosurgery has come to play an important role in the management of patients with nonfunctioning pituitary adenomas. This study examines the outcomes after radiosurgery in a large, multicenter patient population. Methods. Under the auspices of the North American Gamma Knife Consortium, 9 Gamma Knife surgery (GKS) centers retrospectively combined their outcome data obtained in 512 patients with nonfunctional pituitary adenomas. Prior resection was performed in 479 patients (93.6%) and prior fractionated external-beam radiotherapy was performed in 34 patients (6.6%). The median age at the time of radiosurgery was 53 years. Fifty-eight percent of patients had some degree of hypopituitarism prior to radiosurgery. Patients received a median dose of 16 Gy to the tumor margin. The median follow-up was 36 months (range 1-223 months). Results. Overall tumor control was achieved in 93.4% of patients at last follow-up; actuarial tumor control was 98%, 95%, 91%, and 85% at 3, 5, 8, and 10 years postradiosurgery, respectively. Smaller adenoma volume (OR 1.08 [95% CI 1.02-1.13], p = 0.006) and absence of suprasellar extension (OR 2.10 [95% CI 0.96-4.61], p = 0.064) were associated with progression-free tumor survival. New or worsened hypopituitarism after radiosurgery was noted in 21% of patients, with thyroid and cortisol deficiencies reported as the most common postradiosurgery endocrinopathies. History of prior radiation therapy and greater tumor margin doses were predictive of new or worsening endocrinopathy after GKS. New or progressive cranial nerve deficits were noted in 9% of patients; 6.6% had worsening or new onset optic nerve dysfunction. In multivariate analysis, decreasing age, increasing volume, history of prior radiation therapy, and history of prior pituitary axis deficiency were predictive of new or worsening cranial nerve dysfunction. No patient died as a result of tumor progression. Favorable outcomes of tumor control and neurological preservation were reflected in a 4-point radiosurgical pituitary score. Conclusions. Gamma Knife surgery is an effective and well-tolerated management strategy for the vast majority of patients with recurrent or residual nonfunctional pituitary adenomas. Delayed hypopituitarism is the most common complication after radiosurgery. Neurological and cranial nerve function were preserved in more than 90% of patients after radiosurgery. The radiosurgical pituitary score may predict outcomes for future patients who undergo GKS for a nonfunctioning adenoma.

Original languageEnglish
Pages (from-to)446-456
Number of pages11
JournalJournal of Neurosurgery
Volume119
Issue number2
DOIs
Publication statusPublished - 2013 Aug 1
Externally publishedYes

Fingerprint

Radiosurgery
Pituitary Neoplasms
Multicenter Studies
Hypopituitarism
Cranial Nerves
Neoplasms
Adenoma
Radiotherapy
Optic Nerve
Brain Neoplasms
Disease-Free Survival
Hydrocortisone
Thyroid Gland

Keywords

  • Gamma Knife
  • Oncology
  • Pituitary adenoma
  • Pituitary surgery
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Sheehan, J. P., Starke, R. M., Mathieu, D., Young, B., Sneed, P. K., Chiang, V. L., ... Lunsford, L. D. (2013). Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: A multicenter study. Journal of Neurosurgery, 119(2), 446-456. https://doi.org/10.3171/2013.3.JNS12766

Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas : A multicenter study. / Sheehan, Jason P.; Starke, Robert M.; Mathieu, David; Young, Byron; Sneed, Penny K.; Chiang, Veronica L.; Lee, John Y.K.; Kano, Hideyuki; Park, Kyung-Jae; Niranjan, Ajay; Kondziolka, Douglas; Barnett, Gene H.; Rush, Stephen; Golfinos, John G.; Lunsford, L. Dade.

In: Journal of Neurosurgery, Vol. 119, No. 2, 01.08.2013, p. 446-456.

Research output: Contribution to journalArticle

Sheehan, JP, Starke, RM, Mathieu, D, Young, B, Sneed, PK, Chiang, VL, Lee, JYK, Kano, H, Park, K-J, Niranjan, A, Kondziolka, D, Barnett, GH, Rush, S, Golfinos, JG & Lunsford, LD 2013, 'Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: A multicenter study', Journal of Neurosurgery, vol. 119, no. 2, pp. 446-456. https://doi.org/10.3171/2013.3.JNS12766
Sheehan, Jason P. ; Starke, Robert M. ; Mathieu, David ; Young, Byron ; Sneed, Penny K. ; Chiang, Veronica L. ; Lee, John Y.K. ; Kano, Hideyuki ; Park, Kyung-Jae ; Niranjan, Ajay ; Kondziolka, Douglas ; Barnett, Gene H. ; Rush, Stephen ; Golfinos, John G. ; Lunsford, L. Dade. / Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas : A multicenter study. In: Journal of Neurosurgery. 2013 ; Vol. 119, No. 2. pp. 446-456.
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abstract = "Object. Pituitary adenomas are fairly common intracranial neoplasms, and nonfunctioning ones constitute a large subgroup of these adenomas. Complete resection is often difficult and may pose undue risk to neurological and endocrine function. Stereotactic radiosurgery has come to play an important role in the management of patients with nonfunctioning pituitary adenomas. This study examines the outcomes after radiosurgery in a large, multicenter patient population. Methods. Under the auspices of the North American Gamma Knife Consortium, 9 Gamma Knife surgery (GKS) centers retrospectively combined their outcome data obtained in 512 patients with nonfunctional pituitary adenomas. Prior resection was performed in 479 patients (93.6{\%}) and prior fractionated external-beam radiotherapy was performed in 34 patients (6.6{\%}). The median age at the time of radiosurgery was 53 years. Fifty-eight percent of patients had some degree of hypopituitarism prior to radiosurgery. Patients received a median dose of 16 Gy to the tumor margin. The median follow-up was 36 months (range 1-223 months). Results. Overall tumor control was achieved in 93.4{\%} of patients at last follow-up; actuarial tumor control was 98{\%}, 95{\%}, 91{\%}, and 85{\%} at 3, 5, 8, and 10 years postradiosurgery, respectively. Smaller adenoma volume (OR 1.08 [95{\%} CI 1.02-1.13], p = 0.006) and absence of suprasellar extension (OR 2.10 [95{\%} CI 0.96-4.61], p = 0.064) were associated with progression-free tumor survival. New or worsened hypopituitarism after radiosurgery was noted in 21{\%} of patients, with thyroid and cortisol deficiencies reported as the most common postradiosurgery endocrinopathies. History of prior radiation therapy and greater tumor margin doses were predictive of new or worsening endocrinopathy after GKS. New or progressive cranial nerve deficits were noted in 9{\%} of patients; 6.6{\%} had worsening or new onset optic nerve dysfunction. In multivariate analysis, decreasing age, increasing volume, history of prior radiation therapy, and history of prior pituitary axis deficiency were predictive of new or worsening cranial nerve dysfunction. No patient died as a result of tumor progression. Favorable outcomes of tumor control and neurological preservation were reflected in a 4-point radiosurgical pituitary score. Conclusions. Gamma Knife surgery is an effective and well-tolerated management strategy for the vast majority of patients with recurrent or residual nonfunctional pituitary adenomas. Delayed hypopituitarism is the most common complication after radiosurgery. Neurological and cranial nerve function were preserved in more than 90{\%} of patients after radiosurgery. The radiosurgical pituitary score may predict outcomes for future patients who undergo GKS for a nonfunctioning adenoma.",
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T1 - Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas

T2 - A multicenter study

AU - Sheehan, Jason P.

AU - Starke, Robert M.

AU - Mathieu, David

AU - Young, Byron

AU - Sneed, Penny K.

AU - Chiang, Veronica L.

AU - Lee, John Y.K.

AU - Kano, Hideyuki

AU - Park, Kyung-Jae

AU - Niranjan, Ajay

AU - Kondziolka, Douglas

AU - Barnett, Gene H.

AU - Rush, Stephen

AU - Golfinos, John G.

AU - Lunsford, L. Dade

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Object. Pituitary adenomas are fairly common intracranial neoplasms, and nonfunctioning ones constitute a large subgroup of these adenomas. Complete resection is often difficult and may pose undue risk to neurological and endocrine function. Stereotactic radiosurgery has come to play an important role in the management of patients with nonfunctioning pituitary adenomas. This study examines the outcomes after radiosurgery in a large, multicenter patient population. Methods. Under the auspices of the North American Gamma Knife Consortium, 9 Gamma Knife surgery (GKS) centers retrospectively combined their outcome data obtained in 512 patients with nonfunctional pituitary adenomas. Prior resection was performed in 479 patients (93.6%) and prior fractionated external-beam radiotherapy was performed in 34 patients (6.6%). The median age at the time of radiosurgery was 53 years. Fifty-eight percent of patients had some degree of hypopituitarism prior to radiosurgery. Patients received a median dose of 16 Gy to the tumor margin. The median follow-up was 36 months (range 1-223 months). Results. Overall tumor control was achieved in 93.4% of patients at last follow-up; actuarial tumor control was 98%, 95%, 91%, and 85% at 3, 5, 8, and 10 years postradiosurgery, respectively. Smaller adenoma volume (OR 1.08 [95% CI 1.02-1.13], p = 0.006) and absence of suprasellar extension (OR 2.10 [95% CI 0.96-4.61], p = 0.064) were associated with progression-free tumor survival. New or worsened hypopituitarism after radiosurgery was noted in 21% of patients, with thyroid and cortisol deficiencies reported as the most common postradiosurgery endocrinopathies. History of prior radiation therapy and greater tumor margin doses were predictive of new or worsening endocrinopathy after GKS. New or progressive cranial nerve deficits were noted in 9% of patients; 6.6% had worsening or new onset optic nerve dysfunction. In multivariate analysis, decreasing age, increasing volume, history of prior radiation therapy, and history of prior pituitary axis deficiency were predictive of new or worsening cranial nerve dysfunction. No patient died as a result of tumor progression. Favorable outcomes of tumor control and neurological preservation were reflected in a 4-point radiosurgical pituitary score. Conclusions. Gamma Knife surgery is an effective and well-tolerated management strategy for the vast majority of patients with recurrent or residual nonfunctional pituitary adenomas. Delayed hypopituitarism is the most common complication after radiosurgery. Neurological and cranial nerve function were preserved in more than 90% of patients after radiosurgery. The radiosurgical pituitary score may predict outcomes for future patients who undergo GKS for a nonfunctioning adenoma.

AB - Object. Pituitary adenomas are fairly common intracranial neoplasms, and nonfunctioning ones constitute a large subgroup of these adenomas. Complete resection is often difficult and may pose undue risk to neurological and endocrine function. Stereotactic radiosurgery has come to play an important role in the management of patients with nonfunctioning pituitary adenomas. This study examines the outcomes after radiosurgery in a large, multicenter patient population. Methods. Under the auspices of the North American Gamma Knife Consortium, 9 Gamma Knife surgery (GKS) centers retrospectively combined their outcome data obtained in 512 patients with nonfunctional pituitary adenomas. Prior resection was performed in 479 patients (93.6%) and prior fractionated external-beam radiotherapy was performed in 34 patients (6.6%). The median age at the time of radiosurgery was 53 years. Fifty-eight percent of patients had some degree of hypopituitarism prior to radiosurgery. Patients received a median dose of 16 Gy to the tumor margin. The median follow-up was 36 months (range 1-223 months). Results. Overall tumor control was achieved in 93.4% of patients at last follow-up; actuarial tumor control was 98%, 95%, 91%, and 85% at 3, 5, 8, and 10 years postradiosurgery, respectively. Smaller adenoma volume (OR 1.08 [95% CI 1.02-1.13], p = 0.006) and absence of suprasellar extension (OR 2.10 [95% CI 0.96-4.61], p = 0.064) were associated with progression-free tumor survival. New or worsened hypopituitarism after radiosurgery was noted in 21% of patients, with thyroid and cortisol deficiencies reported as the most common postradiosurgery endocrinopathies. History of prior radiation therapy and greater tumor margin doses were predictive of new or worsening endocrinopathy after GKS. New or progressive cranial nerve deficits were noted in 9% of patients; 6.6% had worsening or new onset optic nerve dysfunction. In multivariate analysis, decreasing age, increasing volume, history of prior radiation therapy, and history of prior pituitary axis deficiency were predictive of new or worsening cranial nerve dysfunction. No patient died as a result of tumor progression. Favorable outcomes of tumor control and neurological preservation were reflected in a 4-point radiosurgical pituitary score. Conclusions. Gamma Knife surgery is an effective and well-tolerated management strategy for the vast majority of patients with recurrent or residual nonfunctional pituitary adenomas. Delayed hypopituitarism is the most common complication after radiosurgery. Neurological and cranial nerve function were preserved in more than 90% of patients after radiosurgery. The radiosurgical pituitary score may predict outcomes for future patients who undergo GKS for a nonfunctioning adenoma.

KW - Gamma Knife

KW - Oncology

KW - Pituitary adenoma

KW - Pituitary surgery

KW - Stereotactic radiosurgery

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