Stereotactic Radiosurgery for Pituitary Tumors

2015 ◽  
pp. 55-65 ◽  
Author(s):  
Thomas C. Witt ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Pituitary Tumors

Efficacy of magnetic resonance imaging at 3 T compared with 1.5 T in small pituitary tumors for stereotactic radiosurgery planning

2013 ◽  
Vol 32 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Hisato Nakazawa ◽  
Yuta Shibamoto ◽  
Takahiko Tsugawa ◽  
Yoshimasa Mori ◽  
Masami Nishio ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Stereotactic Radiosurgery ◽  
Pituitary Tumors ◽  
Resonance Imaging

scholarly journals SUN-272 Significant Response to Temozolomide in Two Aggressively Growing Pituitary Adenomas

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ilonka Kreitschmann-Andermahr ◽  
Agnieszka Grzywotz ◽  
Claudia Möller-Hartmann ◽  
Andreas Junker ◽  
Dagmer Führer-Sakel ◽  
...  
Keyword(s):  
Visual Field ◽  
Tumor Growth ◽  
Stereotactic Radiosurgery ◽  
Pituitary Adenomas ◽  
Therapeutic Option ◽  
Pituitary Tumors ◽  
Significant Response ◽  
Double Vision ◽  
Heavily Pretreated ◽  
Case Presentations

Abstract Introduction: Aggressive atypical pituitary tumors are characterized by invasive growth, recurrence and resistance to standard therapies. We present two female patients with pituitary adenomas in whom multiple other therapies had failed, who presented with significant response to temozolomide. Case presentations: In patient #1 (w, 78y), the diagnosis of macroprolactinoma had been made in a community hospital and dopaminagonistic treatment with bromocriptin had been initiated. After failure to achieve significant tumor reduction under this treatment and persisting visual field disturbances, first transnasal-transphenoidal surgery (TSS) was performed in 07/2011, followed by cabergoline exposure in increasing dose due to failure to control prolactin levels. Repeat TSS and stereotactic radiosurgery were performed in both 2014 and 2018 because of invasive tumor growth and double vision. She was then put on temozolomide. Patient #2 (w, 58y) presented with apoplectic gonadotropinoma in 2013. She also underwent 3 courses of TSS as well as stereotactic radiosurgery because of repeated tumor growth leading to visual field disturbances and double vision. Despite these measures, the tumor could not be controlled and she, as well, was put on temozolomide in 2018. In both cases costs were reimbursed by the patient’s health care insurance and in both the first cycle was conducted with 150 mg/ body surface area (BSA) with escalation to 200 mg/BSA in the second. After only 2 cycles, double vision resolved in both patients and the tumor had shrunk by approximately 20% on MRI in patient #1 and even more in patient #2. In both patients, temozolomide dose was reduced again to 150 mg/BSA due to side effects. Nevertheless, in both patients tumor volume further continued to decrease under therapy. Conclusion: This promising clinical course after exposure to temozolomide with early, significant tumor shrinkage in two heavily pretreated patients with aggressive pituitary adenomas indicates that this therapy can be considered also in older patients and may yield astonishing results. Although temozolomide is increasingly becoming a therapeutic option for those patients whose pituitary tumors are refractory to standard therapies, further research and observance over time of temozolomide therapy in aggressive pituitary adenomas and carcinomas is indicated.

Adrenocorticotropic Hormone-producing Pituitary Tumors: 12- to 22-year Follow-up after Treatment with Stereotactic Radiosurgery

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 284-292 ◽  
Author(s):  
Charlotte Höybye ◽  
Eva Grenbäck ◽  
Tiit Rähn ◽  
Marie Degerblad ◽  
Marja Thorén ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Adrenocorticotropic Hormone ◽  
Visual Fields ◽  
Pituitary Tumors ◽  
Pituitary Hormone ◽  
Pituitary Insufficiency ◽  
Primary Therapy ◽  
Radiation Induced ◽  
Effect Of Treatment

Abstract OBJECTIVE To study retrospectively long-term outcomes of patients with adrenocorticotropic hormone-producing pituitary tumors that were treated with stereotactic Leksell gamma knife unit radiosurgery. METHODS Eighty-nine patients aged 5 to 67 years were treated between 1976 and 1985. Eighteen patients aged 18 to 68 years (mean age, 41 yr) were followed in detail. Fifteen patients were women. None had previously received conventional radiotherapy, but pituitary microsurgery had been performed in two patients, and one patient had had an adrenalectomy. In the remaining 15 patients, radiosurgery was the primary therapy. RESULTS Sixty-four patients had one stereotactic treatment, and 25 patients had two or more treatments. No complications were observed during treatment and the immediate follow-up period. At follow-up, 17 patients had died 1 to 20 years after the first treatment. No deaths were related to the treatment. In our 18 patients, the follow-up time after the first radiosurgical treatment was 12 to 22 years (mean follow-up period, 17 yr). Urinary cortisol levels gradually normalized in 83% of the patients. No recurrences were observed. Pituitary hormone insufficiencies developed in about two of every three patients and occurred even more than 10 years after treatment. Eight patients had transient hyperprolactinemia. The patients' vision and visual fields were unaffected, and none of them had signs of radiation-induced side effects such as brain tumors or brain necrosis. CONCLUSION Stereotactic radiosurgery is a safe and effective method in the treatment of patients with adrenocorticotropic hormone-producing pituitary tumors, and the effect of treatment is long-lasting. Stereotactic radiosurgery is mainly a complement to microsurgery because of its gradually appearing effect and the occurrence of pituitary insufficiency. New pituitary deficiencies may be found more than 10 years after treatment.

Stereotactic Radiosurgery with the Cobalt-60 Gamma Unit in the Treatment of Growth Hormone-Producing Pituitary Tumors

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 663-668 ◽  
Author(s):  
Marja Thorén ◽  
Tiit Rähn ◽  
Guo Wan-Yuo ◽  
Werner Sigbritt
Keyword(s):  
Growth Hormone ◽  
Stereotactic Radiosurgery ◽  
Clinical Signs ◽  
Young Patients ◽  
Pituitary Tumors ◽  
Normal Serum ◽  
External Irradiation ◽  
Clinical Activity ◽  
Radiation Doses ◽  
Pituitary Insufficiency

Abstract Stereotactic radiosurgery on the pituitary given with the cobalt-60 gamma unit was used in the treatment of 21 patients with growth hormone (GH)-producing pituitary adenomas and acromegaly. All but one patient had locally invasive macroadenomas, and in the majority of cases, there was parasellar growth. Radiosurgery was the initial treatment for seven patients. Fourteen patients were previously treated by pituitary surgery, eight of whom had undergone conventional external pituitary irradiation as well. All patients had clinical signs of active acromegaly before radiosurgery. The radiation doses given to the previously untreated patients or those who only underwent surgery were 40 to 70 Gy in each of one to three irradiations. The patients with previous external irradiation received a lower dose of 30 to 50 Gy in each of one or two irradiations. The patients were observed during a period of 1 to 21 years from the first radiosurgical session. Two young patients had a clinical remission with a substantial decline of GH levels to near normal serum profiles. Another eight patients obtained reduction of GH levels and clinical activity. More than half of the patients (11 of 21) had minor or no effects from the treatment. There were no complications from the radiosurgery except the development of pituitary insufficiency in 2 of 13 patients who did not undergo previous conventional external irradiation. The remission rates were lower than the results previously reported by us for radiosurgery for Cushing's disease. This may be a result of the predominance in the present study of invasive macroadenomas and single treatments and to the lower radiation doses used in the patients who underwent conventional irradiation previously. In the future, the effect of higher radiation doses will be evaluated. The presently available stereotactic magnetic resonance imaging with contrast enhancement, which improves the visualization of the target volume, may aid in improving future radiosurgical results in the treatment of GH-producing pituitary tumors.

Adrenocorticotropic Hormone-producing Pituitary Tumors: 12- to 22-year Follow-up after Treatment with Stereotactic Radiosurgery

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 284-292 ◽  
Author(s):  
Charlotte Höybye ◽  
Eva Grenbäck ◽  
Tiit Rähn ◽  
Marie Degerblad ◽  
Marja Thorén ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Adrenocorticotropic Hormone ◽  
Pituitary Tumors

Radiotherapy and stereotactic radiosurgery for pituitary tumors

2003 ◽  
Vol 14 (1) ◽  
pp. 147-166 ◽  
Author(s):  
Zbigniew Petrovich ◽  
Gabor Jozsef ◽  
Cheng Yu ◽  
Michael L.J Apuzzo
Keyword(s):  
Stereotactic Radiosurgery ◽  
Pituitary Tumors

Stereotactic radiosurgery for pituitary tumors

2003 ◽  
Vol 14 (5) ◽  
pp. 1-12 ◽  
Author(s):  
Thomas C. Witt
Keyword(s):  
Stereotactic Radiosurgery ◽  
Pituitary Adenomas ◽  
Hormone Secretion ◽  
Growth Control ◽  
Pituitary Tumors ◽  
Clinical Situation ◽  
Endocrine Response ◽  
Advantages And Disadvantages ◽  
Rates Of Growth ◽  
Clinical Problems

Pituitary adenomas frequently pose challenging clinical problems. Stereotactic radiosurgery (SRS) is one treatment option in selected patients. The purpose of this report is to identify the advantages and disadvantages of radiosurgery in cases of pituitary tumors to assess better its role in relation to other treatment. Methods for optimizing outcome are described. The author reviews several recent series to determine rates of growth control, endocrine response, and complications. In general, growth control is excellent, complications are very low, and reduction of excessive hormone secretion is fair. Depending on the clinical situation, SRS may be the treatment of choice in selected patients.

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