Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas.

Autor:	Shaaban A; 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia., Dumot C; 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.; 2Department of Neurological Surgery, Hospices Civils de Lyon, France., Mantziaris G; 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia., Dayawansa S; 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia., Peker S; 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey., Samanci Y; 3Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey., Nabeel AM; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; 5Neurosurgery Department, Faculty of Medecine, Benha University, Qalubya, Egypt., Reda WA; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; Departments of6Neurosurgery and., Tawadros SR; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; Departments of6Neurosurgery and., Abdel Karim K; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; 7Clinical Oncology, Ain Shams University, Cairo, Egypt., El-Shehaby AMN; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; Departments of6Neurosurgery and., Emad Eldin RM; 4Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.; 8Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt., Ragab Abdelsalam A; 9Neurosurgery Department, Military Medical Academy, Cairo, Egypt; and., Liscak R; 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic., May J; 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic., Mashiach E; Departments of11Neurosurgery and., De Nigris Vasconcellos F; Departments of11Neurosurgery and., Bernstein K; 12Radiation Oncology, NYU Langone, New York, New York., Kondziolka D; Departments of11Neurosurgery and., Speckter H; 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic., Mota R; 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic., Brito A; 13Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic., Bindal SK; 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Niranjan A; 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Lunsford LD; 14University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Benjamin CG; Departments of15Neurosurgery and., Almeida T; 16Radiation Oncology, University of Miami, Florida., Mao JZ; Departments of15Neurosurgery and., Mathieu D; 17Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada., Tourigny JN; 17Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada., Tripathi M; 18Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India., Palmer JD; 19Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, Ohio., Matsui J; 19Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, Ohio., Crooks J; 20Drexel University College of Medicine, Philadelphia, Pennsylvania; and., Wegner RE; 21Allegheny Health Network Cancer and Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania., Shepard MJ; 21Allegheny Health Network Cancer and Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania., Sheehan JP; 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2024 Mar 22; Vol. 141 (3), pp. 773-780. Date of Electronic Publication: 2024 Mar 22 (Print Publication: 2024).
DOI:	10.3171/2024.1.JNS232285
Abstrakt:	Objective: Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. Methods: This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. Results: There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. Conclusions: SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
Databáze:	MEDLINE
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