Fractionated Stereotactic Radiotherapy For Pituitary Adenomas Following Microsurgical Resection: Safety and Efficacy

Shearwood McClelland III M.D.¹, Patrick D. Higgins Ph.D.², Bruce J. Gerbi Ph.D.², James B. Orner M.D.², Walter A. Hall M.D., M.B.A.¹

Departments of ¹Neurosurgery and ²Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN

Introduction:

The treatment of pituitary adenomas following medical management has historically involved surgical excision or stereotactic radiosurgery, with the two modalities often utilized collectively. However, there have been only a limited number of reports on the use of fractionated stereotactic radiotherapy (FSRT) for the treatment of pituitary adenomas. To enhance the existing knowledge regarding the safety and efficacy of this treatment modality, we describe our initial experience with FSRT for residual pituitary adenomas following microsurgical resection.

Methods:

From 1999 to 2005, 14 patients (7F, 7M) with residual pituitary adenomas (7 nonsecretory, 2 growth hormone secreting, 2 prolactin secreting, 2 thyrotropin secreting, 1 adrenocorticotropic hormone secreting) underwent FSRT. All patients were planned using the Radionics X-Knife 3D planning system, and received a median dose of 50.4 Gy in daily 1.8 Gy fractions administered to the 90% prescription isodose line. Treatments were delivered stereotactically using a dedicated Varian 6/100 linear accelerator, with immobilization achieved with the Gill-Thomas-Cosman relocatable head frame. Mean tumor size was 3.6 cm (median, 3.2 cm), and mean patient age was 44.6 years (median, 47 years). The mean dosages to the optic chiasm and brainstem were 0.159 and 0.040 Gy (median, 0.163 and 0.031 Gy) per fraction. All patients were evaluated with visual field testing and pre- and postgadolinium-enhanced magnetic resonance imaging at a minimum of one year follow-up (median, 22.5 months; mean, 27.8 months).

Results:

Following FSRT, local control (defined as absence of tumor progression) was achieved in all fourteen patients. Three patients developed hypopituitarism (average, 30 months after treatment), with no patient experiencing visual changes or acute complications following FSRT.

Conclusion:

These results demonstrate the efficacy and safety of FSRT for achieving long-term local tumor control for pituitary adenomas, further validating this technique as an appropriate treatment modality for residual adenomas following microsurgery.

Keywords:

Fractionated Stereotactic Radiotherapy, Pituitary Adenoma, Cavernous Sinus, Residual Tumor Control, Morbidity