Ahead of Print: Whole-Sellar Stereotactic Radiosurgery for Functioning Pituitary Adenomas

Background: Functioning pituitary adenomas (FPA) can be difficult to delineate on post-operative MRI, making them difficult targets for stereotactic radiosurgery (SRS). In such cases, radiation delivery to the entire sella has been utilized as a radiosurgical equivalent of a total hypophysectomy.

Objective: To evaluate the outcomes of a cohort of patients with FPA who underwent SRS to the whole-sellar region.

Methods: This is a retrospective review of patients who underwent whole-sellar SRS for FPA between 1989 and 2012. Sixty-four patients met the inclusion criteria: they were treated with whole-sellar SRS following surgical resection for persistently elevated hormone levels, and 1) no visible lesions on imaging studies, and/or 2) tumor infiltration of dura or adjacent venous sinuses observed at the time of a prior resection. The median radiosurgical volume covering sellar structures was 3.2 mL, with a median margin dose of 25 Gy.

Results: The median endocrine follow-up was 41 months; 22 (68.8%) patients with acromegaly, 20 (71.4%) patients with Cushing’s disease, and 2 (50.0%) patients with prolactinoma achieved endocrine remission. The 2-, 4-, and 6-year actuarial remission rates were 54%, 78%, and 87%, respectively. New onset neurologic deficit was found in 4 (6.3%) patients following treatment. New onset hypopituitarism was observed in 27 (43.5%) patients, with panhypopituitarism in 2 (3.2%). Higher margin/maximum dose were significantly associated with a higher remission rate and development of post-SRS hypopituitarism.

Conclusion: Whole-sellar SRS for invasive or imaging-negative FPA following failed resection can offer reasonable rates of endocrine remission. Hypopituitarism following whole sellar SRS is the most common complication.

From: Whole-Sellar Stereotactic Radiosurgery for Functioning Pituitary Adenomas by Lee et al.

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