Effective time window in reducing pituitary adenoma size by gamma knife radiosurgery

被引:21
作者
Mak, Henry Ka-Fung [1 ]
Lai, Shui-Wun [1 ]
Qian, Wenshu [1 ]
Xu, Stanley [2 ]
Tong, Elizabeth [3 ]
Vance, May Lee [4 ]
Oldfield, Edward [2 ]
Jane, John, Jr. [2 ]
Sheehan, Jason [2 ]
Yau, Kelvin K. W. [5 ]
Wintermark, Max [3 ]
机构
[1] Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Hong Kong, Peoples R China
[2] Univ Virginia, Dept Neurosurg, Charlottesville, VA 22908 USA
[3] Univ Virginia, Dept Radiol, Neuroradiol Div, Charlottesville, VA 22908 USA
[4] Univ Virginia, Dept Med, Charlottesville, VA 22908 USA
[5] City Univ Hong Kong, Dept Management Sci, Hong Kong, Hong Kong, Peoples R China
关键词
Pituitary adenoma; Gamma knife radiosurgery; Therapeutic time window; Magnetic resonance imaging; Tumor control; LONG-TERM EXPERIENCE; OF-THE-LITERATURE; STEREOTACTIC RADIOSURGERY; FOLLOW-UP; TRANSSPHENOIDAL SURGERY; VOLUMETRIC-ANALYSIS; CLINICAL ARTICLE; EFFICACY; RADIOTHERAPY; MACROADENOMA;
D O I
10.1007/s11102-014-0603-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Although the effectiveness of gamma knife radiosurgery (GKRS) in controlling the size of pituitary adenomas has been well demonstrated in many studies, the time period in which significant changes in tumor size occurs has been investigated in a limited fashion. It is important to determine the therapeutic window of GKRS in treating pituitary adenomas, i.e., the effective timeframe during which significant size reduction of these tumors occurs, so that alternative treatments such as further GKRS or microsurgery might be prescribed in a timely manner if clinically indicated. This was a nested sample of an ongoing local cohort study on GKRS for pituitary adenomas at the University of Virginia. Magnetic resonance imaging (MRI) using dedicated sequences was employed. Only patients with a baseline MRI (TP0) and at least 1 follow-up study performed in the University Hospital after GKRS were included. The follow-up scans were performed at five time-points (TP1-TP5) which were 6, 12, 24, 36 and 48 months after GKRS. The dimensional indices of the tumors were measured in three orthogonal planes, i.e., transverse (TR), antero-posterior (AP) and cranio-caudal (CC). The volumes of the tumors were estimated by using the following formula: . Tumor volume decrease by more than 25 % from baseline was considered as 'shrinkage', < 25 % tumor size increase or decrease was considered 'static', and more than 25 % increase as 'increment'. Our cohort consisted of 21 patients, with functioning adenomas in 13 subjects i.e. six adrenocorticotrophic hormone (ACTH)-secreting and seven growth hormone (GH)-secreting, and non-functioning (NF) adenomas in eight subjects. In 26 adenomas (8 ACTH, 9 GH and 9 NF), tumor control (tumor shrinkage or static) were achieved in 21 tumors (80.8 %); 89, 75, and 78 % for GH-secreting, ACTH-secreting and NF adenomas respectively, at the end of the 4-year follow-up period. Analysis of variance showed significant differences of GKRS margin dose among different types of tumors (p = 0.013), but not of baseline tumor volumes (p = 0.240). Logistic regression analysis showed no significant association of margin dose, baseline volume or tumor type with the tumor control outcome. Comparison of tumor change using dimensional indices relative to the base time point (TP0) showed that in the sample there was an average reduction of 1.290 mm at TP1 (6 months) with p values 0.155 (parametric t test) and 0.098 (non-parametric Wilcoxon signed-ranked test) respectively, showing a moderate reduction in tumor dimensional indices. The change in dimensional indices at later time points (TP2-TP5) showed an average reduction ranging from 1.930 to 2.471 mm. Significant reduction in the mean dimensional indices was firstly observed at TP2 (1 year) with p values 0.013 (t test) and 0.018 (Wilcoxon signed-rank test). Such scale of reduction in the dimensional indices appeared to be maintained along the time axis (from TP2 to TP5). Significant decrease in tumor dimensional indices tended to occur at 1 year post-GKRS. Although to a lesser extent, such decrease in dimensional indices continued up to the end of our follow-up period.
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收藏
页码:509 / 517
页数:9
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共 34 条
  • [1] Gamma-knife radiosurgery in acromegaly: A 4-year follow-up study
    Attanasio, R
    Epaminonda, P
    Motti, E
    Giugni, E
    Ventrella, L
    Cozzi, R
    Farabola, M
    Loli, P
    Beck-Peccoz, P
    Arosio, M
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (07) : 3105 - 3112
  • [2] Pituitary irradiation is ineffective in normalizing plasma insulin-like growth factor I in patients with acromegaly
    Barkan, AL
    Halasz, I
    Dornfeld, KJ
    Jaffe, CA
    Friberg, RD
    Chandler, WF
    Sandler, HM
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1997, 82 (10) : 3187 - 3191
  • [3] Radiosurgery for pituitary adenomas
    Brada, M
    Ajithkumar, TV
    Minniti, G
    [J]. CLINICAL ENDOCRINOLOGY, 2004, 61 (05) : 531 - 543
  • [4] Long-Term Results of Stereotactic Radiosurgery in Secretory Pituitary Adenomas
    Castinetti, Frederic
    Nagai, Mariko
    Morange, Isabelle
    Dufour, Henry
    Caron, Philippe
    Chanson, Philippe
    Cortet-Rudelli, Christine
    Kuhn, Jean-Marc
    Conte-Devolx, Bernard
    Regis, Jean
    Brue, Thierry
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (09) : 3400 - 3407
  • [5] Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety
    Castro, Douglas G.
    Cecilio, Soraya A. J.
    Canteras, Miguel M.
    [J]. RADIATION ONCOLOGY, 2010, 5
  • [6] Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function
    Feigl, GC
    Bonelli, CM
    Berghold, A
    Mokry, M
    [J]. JOURNAL OF NEUROSURGERY, 2002, 97 : 415 - 421
  • [7] Results of Gamma Knife Radiosurgery in Acromegaly
    Franzin, Alberto
    Spatola, Giorgio
    Losa, Marco
    Picozzi, Piero
    Mortini, Pietro
    [J]. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY, 2012, 2012
  • [8] Long-term experience of pegvisomant therapy as a treatment for acromegaly
    Higham, C. E.
    Chung, T. T.
    Lawrance, J.
    Drake, W. M.
    Trainer, P. J.
    [J]. CLINICAL ENDOCRINOLOGY, 2009, 71 (01) : 86 - 91
  • [9] Gamma knife radiosurgery for acromegaly: Outcomes after failed transsphenoidal surgery
    Jagannathan, Jay
    Sheehan, Jason P.
    Pouratian, Nader
    Laws, Edward R., Jr.
    Steiner, Ladislau
    Vance, Mary L.
    [J]. NEUROSURGERY, 2008, 62 (06) : 1262 - 1269
  • [10] Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the Gamma Knife
    Jagannathan, Jay
    Yen, Chun-Po
    Pouratian, Nader
    Laws, Edward R.
    Sheehan, Jason P.
    [J]. JOURNAL OF NEURO-ONCOLOGY, 2009, 92 (03) : 345 - 356