Long-Term Outcomes After Cyberknife Radiosurgery for Nonfunctioning Pituitary Adenomas

Author:

Wei Nathan1,Gunawan Kevin2,Tsai Chiao-Ling3,Yang Shih-Hung1,Hsu Feng-Ming3,Lai Dar-Ming1,Xiao Furen45ORCID

Affiliation:

1. Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan;

2. Department of Neurosurgery, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;

3. Department of Oncology, Division of Radiation Oncology, National Taiwan University Hospital, Taipei, Taiwan;

4. Institute of Medical Device and Imaging, National Taiwan University, Taipei, Taiwan;

5. Graduate School of Advanced Technology, National Taiwan University, Taipei, Taiwan

Abstract

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) has been widely adopted as an important adjunctive treatment modality for managing nonfunctioning pituitary adenomas (NFPAs). However, current studies on the long-term effects of SRS on pituitary adenomas have been largely limited by small sample sizes and short follow-up periods. The aim of this study was to evaluate the long-term outcomes of SRS for NFPAs. METHODS: We conducted a retrospective review of 178 patients with NFPAs who received Cyberknife radiosurgery at a single institution between February 2008 and July 2021. Long-term outcomes of tumor control, new-onset hypopituitarism, and new visual disorders were assessed. RESULTS: During a median radiological follow-up of 49.7 months (range, 2.5-158.1 months), only 11 (7.0%) patients experienced tumor progression. The progression-free survival at 3, 5, and 10 years was 97.47%, 95.57%, and 93.04%, respectively. New-onset hypopituitarism was diagnosed in 27 (16.9%) patients with a median clinical follow-up duration of 71.2 months (range, 11.5-175.4 months). The median time from SRS to new-onset hypopituitarism was 28.3 months (range, 2.8-101.7 months). The cumulative incidence of new-onset hypopituitarism at 3, 5, and 10 years was 8.47%, 12.43%, and 15.25%, respectively. Biological effective dose >140 Gy and single fraction equivalent dose >16.0 Gy were significant risk factors for new-onset hypopituitarism (P = .046). Other adverse events were experienced by 15 (8.4%) patients, 9 (5.1%) of whom presented with new visual disorders. Development of new visual disorders was associated with a pretreatment tumor volume of >2.5 mL (P = .044). CONCLUSION: SRS is an effective and relatively safe means of managing both primary and residual/recurrent NFPAs.

Funder

National Science and Technology Council

National Taiwan University Hospital Department of Surgery

Publisher

Ovid Technologies (Wolters Kluwer Health)

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