PURPOSE: This study evaluates the toxicity and outcomes of re-irradiation to the sella for pituitary adenomas. METHODS: Patients diagnosed with a pituitary adenoma and treated with two or more courses of radiation treatment (RT) to the sella were retrospectively analyzed for: initial diagnosis, including histological type and functional status; RT modality, technique, dose, and fractionation; treatment with surgery, endocrine agents, and chemotherapy; toxicity of RT including radiation-induced optic neuropathy, radionecrosis, and radiation-induced neoplasms; and outcomes including local control, distant metastasis, biochemical control of functional tumors, and vital status at last follow-up. RESULTS: We identified 15 patients with non-functioning pituitary adenoma (n = 6), Cushing's disease (CD) (n = 5), acromegaly (n = 3), and prolactinoma (n = 1). Initial RT was delivered using opposed lateral fields in 8 (53%), intensity-modulated radiation therapy (IMRT) in 4 (27%), fractionated stereotactic radiation therapy (FSRT) in 1 (6.7%), and stereotactic radiosurgery (SRS) in 2. The median dose was 49.5 Gy for fractionated RT and 15-25 Gy for SRS. Re-irradiation was performed a median of 5.8 years after initial RT, and delivered using lateral opposed beams (n = 1), IMRT (n = 4), linear-accelerator based SRS (n = 3), FSRT (n = 3), gamma knife surgery (n = 2), and yttrium-90 brachytherapy (n = 1). The median dose of re-irradiation was 45 Gy (range 27.9-54 Gy) for fractionated RT and 18 Gy for SRS. Radiation-induced optic neuropathy (RION) was observed in 2 (13.3%) patients, 6 months and 14 years after re-irradiation; the 5-year rate of RION was 9 %. Temporal lobe necrosis (TLN) occurred in two patients (13.3%), both of whom had received SRS. The 2- and 5-year rates of TLN were 10 and 28%. Actuarial local control rates at 2 and 5 years were 80 and 58%, respectively. Biochemical remission occurred in one of three patients with CD. Four patients (27%) ultimately developed pituitary carcinoma. CONCLUSIONS: Re-irradiation is a feasible treatment option for local control in patients with recalcitrant pituitary adenomas, with acceptable rates of RION and TLN given the lack of options that may be available otherwise. Re-irradiation, however, did not control hormonal hypersecretion.
PURPOSE: This study evaluates the toxicity and outcomes of re-irradiation to the sella for pituitary adenomas. METHODS:Patients diagnosed with a pituitary adenoma and treated with two or more courses of radiation treatment (RT) to the sella were retrospectively analyzed for: initial diagnosis, including histological type and functional status; RT modality, technique, dose, and fractionation; treatment with surgery, endocrine agents, and chemotherapy; toxicity of RT including radiation-induced optic neuropathy, radionecrosis, and radiation-induced neoplasms; and outcomes including local control, distant metastasis, biochemical control of functional tumors, and vital status at last follow-up. RESULTS: We identified 15 patients with non-functioning pituitary adenoma (n = 6), Cushing's disease (CD) (n = 5), acromegaly (n = 3), and prolactinoma (n = 1). Initial RT was delivered using opposed lateral fields in 8 (53%), intensity-modulated radiation therapy (IMRT) in 4 (27%), fractionated stereotactic radiation therapy (FSRT) in 1 (6.7%), and stereotactic radiosurgery (SRS) in 2. The median dose was 49.5 Gy for fractionated RT and 15-25 Gy for SRS. Re-irradiation was performed a median of 5.8 years after initial RT, and delivered using lateral opposed beams (n = 1), IMRT (n = 4), linear-accelerator based SRS (n = 3), FSRT (n = 3), gamma knife surgery (n = 2), and yttrium-90 brachytherapy (n = 1). The median dose of re-irradiation was 45 Gy (range 27.9-54 Gy) for fractionated RT and 18 Gy for SRS. Radiation-induced optic neuropathy (RION) was observed in 2 (13.3%) patients, 6 months and 14 years after re-irradiation; the 5-year rate of RION was 9 %. Temporal lobe necrosis (TLN) occurred in two patients (13.3%), both of whom had received SRS. The 2- and 5-year rates of TLN were 10 and 28%. Actuarial local control rates at 2 and 5 years were 80 and 58%, respectively. Biochemical remission occurred in one of three patients with CD. Four patients (27%) ultimately developed pituitary carcinoma. CONCLUSIONS: Re-irradiation is a feasible treatment option for local control in patients with recalcitrant pituitary adenomas, with acceptable rates of RION and TLN given the lack of options that may be available otherwise. Re-irradiation, however, did not control hormonal hypersecretion.
Authors: Anne W M Lee; Dora L W Kwong; Sing Fai Leung; Stewart Y Tung; Wai Man Sze; Jonathan S T Sham; Peter M L Teo; To Wai Leung; Po Man Wu; Rick Chappell; Lester J Peters; John F Fowler Journal: Int J Radiat Oncol Biol Phys Date: 2002-05-01 Impact factor: 7.038
Authors: A W Lee; W Foo; R Chappell; J F Fowler; W M Sze; Y F Poon; S C Law; S H Ng; S K O; S Y Tung; W H Lau; J H Ho Journal: Int J Radiat Oncol Biol Phys Date: 1998-01-01 Impact factor: 7.038
Authors: J S Loeffler; H M Kooy; P Y Wen; H A Fine; C W Cheng; E G Mannarino; J S Tsai; E Alexander Journal: J Clin Oncol Date: 1990-04 Impact factor: 44.544
Authors: Jason P Sheehan; Ajay Niranjan; Jonas M Sheehan; John A Jane; Edward R Laws; Douglas Kondziolka; John Flickinger; Alex M Landolt; Jay S Loeffler; L Dade Lunsford Journal: J Neurosurg Date: 2005-04 Impact factor: 5.115
Authors: Samuel T Chao; Gene H Barnett; Michael A Vogelbaum; Lilyana Angelov; Robert J Weil; Gennady Neyman; Alwyn M Reuther; John H Suh Journal: Cancer Date: 2008-10-15 Impact factor: 6.860
Authors: Stella K Yoo; Ben A Strickland; Gabriel Zada; Shelly X Bian; Adam Garsa; Jason C Ye; Cheng Yu; Martin H Weiss; Bozena B Wrobel; Steven Giannotta; Eric L Chang Journal: J Neurol Surg B Skull Base Date: 2020-01-14
Authors: Antonio Di Ieva; Fabio Rotondo; Luis V Syro; Michael D Cusimano; Kalman Kovacs Journal: Nat Rev Endocrinol Date: 2014-05-13 Impact factor: 43.330
Authors: Andrew L Lin; Mark T A Donoghue; Sharon L Wardlaw; T Jonathan Yang; Lisa Bodei; Viviane Tabar; Eliza B Geer Journal: J Clin Endocrinol Metab Date: 2020-12-01 Impact factor: 5.958