Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study

Author:

Ironside Natasha1ORCID,Chen Ching-Jen2,Xu Zhiyuan1,Schlesinger David3,Lee Vance Mary4,Hong Gregory K.4,Jane John A.1,Patel Samir5,Bindal Shray K.6,Niranjan Ajay6,Lunsford L. Dade6,Liscak Roman7,Chytka Thomas7,Jezkova Jana8,Saifi Omran9,Trifiletti Daniel M.9,Berger Assaf10,Alzate Juan10,Bernstein Kenneth11,Kondziolka Douglas10,Speckter Herwin12,Hernandez Wenceslao12,Lazo Erwin12,Peker Selcuk13,Samanci Yavuz13,Zacharia Brad E.14,Mau Christine14,Wegner Rodney E.15,Shepard Matthew J.16,Mathieu David17,Maillet Michel18,Sheehan Jason P.1

Affiliation:

1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA;

2. Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA;

3. Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia, USA;

4. Department of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia, USA;

5. Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada;

6. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;

7. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;

8. 3rd Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic;

9. Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA;

10. Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA;

11. Department of Radiation Oncology, NYU Langone Medical Center, New York, New York, USA;

12. Radiology Department, Dominican Gamma Knife Center, CEDIMAT, Santo Domingo, Dominican Republic;

13. Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey;

14. Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, Pennsylvania, USA;

15. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA;

16. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, , USA;

17. Department of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada;

18. Department of Endocrinology, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada

Abstract

BACKGROUND: Delayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas. OBJECTIVE: To investigate the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study. METHODS: We retrospectively reviewed the International Radiosurgery Research Foundation database from January 2002 to December 2021 for adult patients undergoing SRS for pituitary adenomas with >6 months of follow-up. Distances between centers or edges of hypothalamic-pituitary axis structures and SRS target volumes were measured using MRI. The primary outcome was anterior pituitary function preservation. Predictors were analyzed using multivariable logistic regression and area under the receiver operating curve (AUROC) curve analyses. RESULTS: Four hundred eighty-seven patients were categorized by preservation (n = 384) and no preservation (n = 103) of anterior pituitary function. The mean margin dose was 19.1(6.2) Gy. Larger distance from the center of the stalk to the tumor margin isodose was a positive predictor (adjusted odds ratio [aOR] = 1.162 [1.046-1.291], P = .005), while pre-SRS hypopituitarism (aOR = 0.646 [0.405-1.031], P = .067) and larger treatment volume (aOR = 0.965 [0.929-1.002], P = .061) were near negative predictors of the primary outcome. An interaction between the treatment volume and center stalk to margin isodose distance was found (aOR = 0.980 [0.961-0.999], P = .045). Center stalk to margin isodose distance had an AUROC of 0.620 (0.557-0.693), at 3.95-mm distance. For patients with treatment volumes of <2.34 mL, center stalk to margin isodose distance had an AUROC of 0.719 (0.614-0.823), at 2.95-mm distance. CONCLUSION: Achieving a distance between the center of the pituitary stalk and the tumor margin isodose ≥3.95 mm predicted anterior pituitary function preservation. For smaller treatment volumes <2.34 mL, the optimal distance was ≥2.95 mm. This may be modifiable during trans-sphenoidal resection to preserve pituitary function.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Cited by 6 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Hypopituitarism;The Lancet;2024-06

2. Gamma knife radiosurgery is effective in patients with thyrotropin-secreting pituitary adenomas;Journal of Endocrinological Investigation;2024-01-20

3. Pituitary radiotherapy;Reference Module in Biomedical Sciences;2024

4. In Reply: International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends;Neurosurgery;2023-09-13

5. An individualized approach to the management of Cushing disease;Nature Reviews Endocrinology;2023-08-03

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