Evaluation of Gamma Knife Effect on Patients with Pituitary Adenoma | ||
| Iraqi Postgraduate Medical Journal | ||
| Article 13, Volume 20, Issue 1, January 2021, Pages 79-90 PDF (250.25 K) | ||
| Document Type: Research Paper | ||
| DOI: 10.52573/ipmj.2021.167830 | ||
| Authors | ||
| Mohammed Talib Razuki* 1; Yasir Moahammed Hasan Hamandi2 | ||
| 1Resident of Neurosurgery in Neuroscience Hospital; Baghdad, Iraq | ||
| 2Department of Surgery; Al-Nahrain College of Medicine, Baghdad, Iraq. | ||
| Abstract | ||
| BACKGROUND: Pituitary adenomas are common benign brain tumors which account for 15% of all primary brain tumors & 25% of benign brain tumors. It's treatment modality includes medical management and surgery either transcranial or trans-sphenoidal. In recent years, gamma knife radiosurgery has emerged as a treatment modality in the management of pituitary adenoma especially for those cases who have residual tumor and/or those who are not candidate for surgery. PATIENT AND METHODS: This prospective and retrospective study was conducted on 132 pituitary adenoma patients (54 males and 78 females) with a mean age of 45.6 years. Patients were of four groups, 67 with prolactinoma, 10 with somatotroph adenoma, 22 with Cushing disease (ACTH releasing), and 33 with non-functional adenoma. Before performing the gamma knife treatment, a pre-MRI examination was done to these pituitary adenoma patients, then the post-MRI examination was done after 6 months, 1 year and 1.5 year of gamma knife treatment as well as clinical evaluation by examining the type of secretion and hormonal laboratory investigation with visual field assessment. RESULTS: In our study, the most pituitary adenoma group treated with gamma knife was prolactinoma patients (67), with a size of treatment ranging from 2-55 mm, showing 88.05% tumor necrosis; with hormonal level normalization reaching to 82.08%. In the (10) growth hormone releasing adenoma patients, the size of treatment ranged from 5-48 mm, with (90%) tumor necrosis, and (90%) hormonal level normalization. In the (22) ACTH-releasing adenoma patients, the size treated ranged from 3-29 mm, with tumor necrosis of (86.36%), and (81.81%) hormone level normalization, whereas in the (33) non-secretory type of adenoma, the size of treatment ranged from 18-67 mm and the tumor necrosis was 93.93%. CONCLUSION: It can be concluded from this study that gamma knife is an effective and safe option to treat pituitary adenomas by it's low incidence of both morbidity and mortality rate; the tumor necrosis is the highest in non-secretory type when the dose was above 18 grey, but the peri-tumoral edema was found in prolactinoma when the dose of irradiation was above 22 grey. | ||
| Keywords | ||
| Pituitary adenoma; Prolactinoma; Acromegaly; Cushing's disease; Gamma Knife | ||
| References | ||
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1. Leah T Braun, German Rubinstein, Stephanie Zopp, Frederick Vogel, Christine Schmid Tannwald, Montserrat Pazos Eseudero, Jurgen Honegger, Roland Ladurner, Martin Reincke. Recurrence after pituitary surgery in adult Cushing's disease: a systematic review on diagnosis and treatment. Endocrine. 2020; 1- 14. 2. John D Carmichael, Michael S Breder, Dasha Cherepanov, Eunice Chang, Adam Mamelak, Qayyim Said, Maureen P Neary, Vivien Bonert. Long term treatment outcomes of acromegaly patients presenting biochemically- uncontrolled at a tertiary pituitary center. BMC Endocr disord. 2017; 17:49. 3. M Beatriz S Lopes. Pathology of prolactinoma: any predictive value?. Pituitary. 2020; 23: 3-8. 4. Bi W.L., Smith T.R., Nery B., Dunn I.F., Laws E.R. Pituitary tumors: Functioning & Non functioning. In: Winn H.R. (Eds). Yomans & Winn Neurological Surgery. 7th ed. Philadelphia: Elsevier; 2017: 1155-83. 5. Mohammed F El-shirbiny, Raef F.A. Hafez, Nabil Ali, Ashraf A Ezzeldien, Mohammed A Kassim. Role of gamma knife radiosurgery in the management of functioning pituitary adenomas. Benha medical journal. 2015; 6-12. 6. Dale Ding, Robert M Strake, Jason P Sheehan. treatment paradigms for pituitary adenoma: defining the roles of radiosurgery and radiation therapy. Journal of neuro-oncology. 2014;445-57. 7. Giuseppe Minniti, Mattia Falchetto Osti, Maximillian Niyazi. Target delineation and optimal radiosurgical dose for pituitary tumors. Radiation oncology. 2016;135. 8. Raef FA Hafiz, Magad S. Morgan and Osama M Fahmy. Gamma knife surgery in management of secretory pituitary adenoma preliminary evaluation of role; efficacy and safety. Neuroscience discovery. 2014. 9. M L Gheorghia, M Fleseria. Stereotactic radiation therapy in pituitary adenoma, is it better than conventional radiation therapy?. Acta Endocrinol (Buchar). 2017; 476- 90 . 10. Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML. Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 2011;114: 303–9. 11. Won Kim, Claire Clelland, Jsaac Yang, Nader Pouratian. Comprehensive review of stereotactic radiosurgery for medically and surgically refractory pituitary adenomas. Surg Neurol Int. 2012; 579-89. 12. Kita Sallabanda, Sergey Usychkin, Fernando Paebla, Jose' C Bustos, Jose' A Gutie'rrez Diaz, Carmen Peraza, Ce'sar Beltra'n, Hugo Marsiglia, Jose' Sambla's. steriotactic radiosurgery in pituitary adenomas: long term single institution experience and role of the hypothalamic- pituitary axis. J Radiosurg SBRT. 2011; 213- 20. 13. Jana Jezkova', Va'clav Ha'na, Mikula's Kosa'k, Michal Krsek, Roman Lisca'k, Josef Vymazal, Ladislav Pecen, Josef Mark. Role of gamma knife radiosurgery in the treatment of prolactinomas. Pituitary. 2019; 411- 21. 14. John D. Rolston and Lewis S. Blevins, Jr. Gamma knife radiosurgery for acromegaly. International journal of endocrinology. 2012. 15. Josef Marek, Jana Jezkova', Va'clav Ha'na, Michal Krsek, Roman Lisca'k, Vilibald Vladyka, Ledislav Pecen. Gamma knife radiosurgery for Cushing's disease and Nelson's syndrome. Pituitary. 2015; 376- 84. 16. Rosario Pivonello, Monica De Leo, Alessia Cozzolino, Annamaria Colao. The treatment of Cushing's disease. Endocr Rev. 2015; 385- 486. 17. Annamaria Colao, Ludovica FS Grasso, Rosario Pivonello, Gaetano Lombardi. Therapy of aggressive pituitary tumors. Expert opinion on pharmacotherapy. 2011;1561- 70. 18. Cristina Capatina, John AH Wass. 60 years of neuroendocrinology : acromegaly. Journal of endocrinology. 2015; 141- 60. 19. Chi-cheng Chuang, Shinn-yu Lin, Ping Ching Pai, Jiun-lin Yan, Cheng-hong Toh, Shih-tseng Lee, Kuo-chen Wei, Zhuo-hao Liu, Chung-ming Chen, Yu-chi Wang, Cheng-chi Lee. Different Volumetric measurement methods for pituitary adenomas and their crucial clinical significance. Sci Rep. 2017;7: 407-90. 20. Dorothee Wachter, Nicole Gondermann, Mathias F Oertel, UIF Nestler, Veit Rohde, Dieter-karsten Boker. Pituitary insufficiency after operation of supratentorial intra- and extra-axial tumors outside of the sellar- parasellar region?. Neurosurg Rev. 2011; 34: 509- 16.
1. Leah T Braun, German Rubinstein, Stephanie Zopp, Frederick Vogel, Christine Schmid Tannwald, Montserrat Pazos Eseudero, Jurgen Honegger, Roland Ladurner, Martin Reincke. Recurrence after pituitary surgery in adult Cushing's disease: a systematic review on diagnosis and treatment. Endocrine. 2020; 1- 14. 2. John D Carmichael, Michael S Breder, Dasha Cherepanov, Eunice Chang, Adam Mamelak, Qayyim Said, Maureen P Neary, Vivien Bonert. Long term treatment outcomes of acromegaly patients presenting biochemically- uncontrolled at a tertiary pituitary center. BMC Endocr disord. 2017; 17:49. 3. M Beatriz S Lopes. Pathology of prolactinoma: any predictive value?. Pituitary. 2020; 23: 3-8. 4. Bi W.L., Smith T.R., Nery B., Dunn I.F., Laws E.R. Pituitary tumors: Functioning & Non functioning. In: Winn H.R. (Eds). Yomans & Winn Neurological Surgery. 7th ed. Philadelphia: Elsevier; 2017: 1155-83. 5. Mohammed F El-shirbiny, Raef F.A. Hafez, Nabil Ali, Ashraf A Ezzeldien, Mohammed A Kassim. Role of gamma knife radiosurgery in the management of functioning pituitary adenomas. Benha medical journal. 2015; 6-12. 6. Dale Ding, Robert M Strake, Jason P Sheehan. treatment paradigms for pituitary adenoma: defining the roles of radiosurgery and radiation therapy. Journal of neuro-oncology. 2014;445-57. 7. Giuseppe Minniti, Mattia Falchetto Osti, Maximillian Niyazi. Target delineation and optimal radiosurgical dose for pituitary tumors. Radiation oncology. 2016;135. 8. Raef FA Hafiz, Magad S. Morgan and Osama M Fahmy. Gamma knife surgery in management of secretory pituitary adenoma preliminary evaluation of role; efficacy and safety. Neuroscience discovery. 2014. 9. M L Gheorghia, M Fleseria. Stereotactic radiation therapy in pituitary adenoma, is it better than conventional radiation therapy?. Acta Endocrinol (Buchar). 2017; 476- 90 .
10. Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML. Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 2011;114: 303–9. 11. Won Kim, Claire Clelland, Jsaac Yang, Nader Pouratian. Comprehensive review of stereotactic radiosurgery for medically and surgically refractory pituitary adenomas. Surg Neurol Int. 2012; 579-89. 12. Kita Sallabanda, Sergey Usychkin, Fernando Paebla, Jose' C Bustos, Jose' A Gutie'rrez Diaz, Carmen Peraza, Ce'sar Beltra'n, Hugo Marsiglia, Jose' Sambla's. steriotactic radiosurgery in pituitary adenomas: long term single institution experience and role of the hypothalamic- pituitary axis. J Radiosurg SBRT. 2011; 213- 20. 13. Jana Jezkova', Va'clav Ha'na, Mikula's Kosa'k, Michal Krsek, Roman Lisca'k, Josef Vymazal, Ladislav Pecen, Josef Mark. Role of gamma knife radiosurgery in the treatment of prolactinomas. Pituitary. 2019; 411- 21. 14. John D. Rolston and Lewis S. Blevins, Jr. Gamma knife radiosurgery for acromegaly. International journal of endocrinology. 2012. 15. Josef Marek, Jana Jezkova', Va'clav Ha'na, Michal Krsek, Roman Lisca'k, Vilibald Vladyka, Ledislav Pecen. Gamma knife radiosurgery for Cushing's disease and Nelson's syndrome. Pituitary. 2015; 376- 84. 16. Rosario Pivonello, Monica De Leo, Alessia Cozzolino, Annamaria Colao. The treatment of Cushing's disease. Endocr Rev. 2015; 385- 486. 17. Annamaria Colao, Ludovica FS Grasso, Rosario Pivonello, Gaetano Lombardi. Therapy of aggressive pituitary tumors. Expert opinion on pharmacotherapy. 2011;1561- 70. 18. Cristina Capatina, John AH Wass. 60 years of neuroendocrinology : acromegaly. Journal of endocrinology. 2015; 141- 60.
19. Chi-cheng Chuang, Shinn-yu Lin, Ping Ching Pai, Jiun-lin Yan, Cheng-hong Toh, Shih-tseng Lee, Kuo-chen Wei, Zhuo-hao Liu, Chung-ming Chen, Yu-chi Wang, Cheng-chi Lee. Different Volumetric measurement methods for pituitary adenomas and their crucial clinical significance. Sci Rep. 2017;7: 407-90. 20. Dorothee Wachter, Nicole Gondermann, Mathias F Oertel, UIF Nestler, Veit Rohde, Dieter-karsten Boker. Pituitary insufficiency after operation of supratentorial intra- and extra-axial tumors outside of the sellar- parasellar region?. Neurosurg Rev. 2011; 34: 509- 16. | ||
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