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J Neurol Surg B Skull Base 2021; 82(S 03): e51-e58
DOI: 10.1055/s-0040-1710518
Original Article

Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy for Nonfunctioning Pituitary Adenoma

Mohamed H. Khattab   *
1   Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Alexander D. Sherry  ‡   *
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Mark C. Xu
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Patrick Kelly 
3   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Joshua L. Anderson
2   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Guozhen Luo
1   Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Lola B. Chambless
3   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Anthony J. Cmelak
1   Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Albert Attia
1   Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
3   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations Funding None.
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Abstract

Objectives Hypofractionated stereotactic radiotherapy (HSRT) in two to five fractions may offer patients with large nonfunctioning pituitary adenomas (NFPAs) with chiasm involvement a safe and effective treatment over a single week. However, little has been reported regarding this novel approach.

Design We compared the feasibility, outcomes, and toxicity of single-fraction stereotactic radiosurgery and HSRT.

Setting This study was conducted at a tertiary academic referral center.

Participants After approval by the institutional review board, we performed a retrospective cohort study of patients treated at our institution with stereotactic radiosurgery (SRS) and HSRT for NFPA. Selection for SRS or HSRT was based on clinicopathologic factors including tumor size and cavernous sinus invasion at the discretion of the treating physician.

Main Outcome Measures Local control, endocrinopathy, and radiation-associated toxicity were evaluated by binary logistic regression and Cox's proportional hazards regression.

Results A total of 45 patients with mean follow-up of 5 years were enrolled including 26 patients treated by HSRT with mean follow-up of 3 years and 19 patients treated by SRS with median follow-up of 6 years. Clinicopathologic characteristics were balanced between cohorts. Local failure at last follow-up was 5% in the SRS cohort and 8% in the HSRT cohort, and rates of post-SRS endocrinopathy were similar between each cohort. Late complications including radionecrosis, visual deficit, and secondary malignancy were minimal in either cohort.

Conclusions HSRT is an appropriate treatment strategy for patients with NFPAs, particularly for optic pathway preservation in the setting of large tumors with chiasm involvement. Further studies are needed to optimize fractionated approaches and patient selection.

Keywords

Hypofractionated Stereotactic Radiotherapy - stereotactic radiosurgery - non-functioning pituitary adenoma - fractionation - toxicity

* These authors contributed equally to this work.




Publication History

Received: 04 October 2019

Accepted: 14 March 2020

Article published online:
05 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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