Artikel
Risk-adapted radiosurgery or (fractionated) stereotactic radiotherapy of nonsecretory pituitary adenomas leads to high local control with low toxicity – 10 years of experience with the Novalis system
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Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: To evaluate the clinical outcome of risk-adapted radiosurgery (SRS) or stereotactic radiotherapy (SRT) for nonsecretory pituitary adenoma (NSA).
Method: From 2000 to 2010, a total of 121 patients with NSA were treated either with SRS (<4 ccm, low risk) or with fractionated SRT (≥ 4 ccm, close to optic pathways) using the Novalis system. 40 patients were lost for follow-up, 81 were enrolled for this study. 45 patients were male, and 36 were female. The patient’s age ranged from 20 to 82 years (median, 62 years). 68 patients were recurrent; the remaining 13 were inoperable or refused surgery. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Results: Tumor volume ranged from 0.23 to 62.67 ccm (median, 4.05 ccm). Ten patients (12%) were treated with SRS, 71 were treated with SRT (88%). The median follow-up period was 48 months (range, 6–132 months), and 34 Patients had a follow-up of 5 years or more. Local control rates were 100 % with 39 % volumetrically proven tumor shrinkage. A post-SRS/SRT grade 2–3 visual disorder occurred in 2 patients (2.5%). New post-SRS/SRT hypopituitarism was observed in 5 of 22 patients (23%) who had not received hormone replacement therapy after surgery.
Conclusions: After 10 years of experience, we consider risk-adapted SRS or SRT for safe and successful in terms of tumor control and protecting the visual system and neuroendocrine function, especially for tumors located close to the optic pathways and large tumors.