Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas

Kyung Jae Park, Hideyuki Kano, Phillip V. Parry, Ajay Niranjan, John C. Flickinger, L. Dade Lunsford, Douglas Kondziolka

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Abstract

BACKGROUND: Nonfunctional pituitary adenomas (NFPAs) represent approximately 50% of all pituitary tumors. OBJECTIVE: To evaluate the long-term outcomes of stereotactic radiosurgery for NFPAs. METHODS: We evaluated the management outcomes of Gamma Knife radiosurgery in 125 patients with NFPAs over an interval of 22 years. The median patient age was 54 years (range, 16-88 years). One hundred ten patients (88%) had residual or recurrent tumors after ≥ 1 surgical procedures, and 17 (14%) had undergone prior fractionated radiation therapy. The median target volume was 3.5 cm (range, 0.4-28.1 cm 3), and the median tumor margin dose was 13.0 Gy (range, 10-25 Gy). RESULTS: Tumor volume decreased in 66 patients (53%), remained stable in 46 (37%), and increased in 13 (10.4%) during a median of 62 months (maximum, 19 years) of imaging follow-up. The actuarial tumor control rates at 1, 5, and 10 years were 99%, 94%, and 76%, respectively. Factors associated with a reduced progression-free survival included larger tumor volume (≥ 4.5 cm3) and ≥ 2 prior recurrences. Of 88 patients with residual pituitary function, 21 (24%) suffered new hormonal deficits at a median of 24 months (range, 3-114 months). Prior radiation therapy increased the risk of developing new pituitary hormonal deficits. One patient (0.8%) had a decline in visual function, and 2 (1.6%) developed new cranial neuropathies without tumor progression. CONCLUSION: Stereotactic radiosurgery can provide effective management for patients with newly diagnosed NFPAs and for those after prior resection and/or radiation therapy.

Original languageEnglish
Pages (from-to)1188-1198
Number of pages11
JournalNeurosurgery
Volume69
Issue number6
DOIs
Publication statusPublished - 2011 Dec

Keywords

  • Gamma Knife
  • Nonfunctional tumor
  • Pituitary adenoma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Park, K. J., Kano, H., Parry, P. V., Niranjan, A., Flickinger, J. C., Lunsford, L. D., & Kondziolka, D. (2011). Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery, 69(6), 1188-1198. https://doi.org/10.1227/NEU.0b013e318222afed