Long-term Results Of Stereotactic Radiosurgery: Should We Modify Our Management Strategy Of Pituitary Adenomas?

Keywords: pituitary adenoma, outcome, gamma knife, Cushing's disease, acromegaly

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     To determine long-term efficacy and adverse effects of GK in secreting pituitary adenomas. This is a retrospective study of patients treated by GK in the center of Marseille, France, with a follow-up at least equal to 60 months.
     76 patients were treated by GK for acromegaly (n=43), Cushing’s disease (CD, n=18) or prolactinoma (n=15), as a primary (n=27) or adjunctive post-surgical treatment (n=49).
     After withdrawal of antisecretory drugs, patients were considered in remission if they had mean GH levels < 2 ng/ml and normal IGF1 (acromegaly), normal 24h urinary free cortisol and cortisol < 50 nmol/l after low dose dexamethasone test (CD), or 2 consecutive normal samplings of prolactin levels (prolactinoma).
     After a mean follow-up of 96 months, 44.7% of the patients were in remission. Mean time to remission was 42.6 months. Twelve patients presented late remission at least 48 months after GK. Two patients with CD presented late recurrence 72 and 96 months after GK. Forty percent of patients treated primarily with GK were in remission. Target volume and initial hormone levels were significant predictive factors of remission in univariate analysis. Radiation-induced hypopituitarism was observed in 23% patients; in half of them, hypopituitarism was observed after a mean time of 48 to 96 months. Twenty-four patients were followed more than 120 months: rates of remission and hypopituitarism were similar to the whole cohort.
     This is a retrospective study.
     GK is an effective and safe primary or adjunctive treatment in selected patients with secreting pituitary adenomas. 
     All these data show that SR is probably still useful in the therapeutic algorithms of pituitary adenomas, despite the fact that antisecretory drugs, particularly for acromegaly, are becoming more and more effective and well tolerated.


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