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Outcome of fractionated stereotactic radiotherapy in patients with pituitary adenomas resistant to conventional treatments: a 5·25‐year follow‐up study
Author(s) -
SchalinJäntti Camilla,
Valanne Leena,
Tenhunen Mikko,
Setälä Kirsi,
Paetau Anders,
Sane Timo,
Kouri Mauri
Publication year - 2010
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2009.03755.x
Subject(s) - acromegaly , medicine , hypopituitarism , radiation therapy , progressive disease , radiosurgery , visual acuity , stereotactic radiotherapy , pituitary neoplasm , pituitary gland , urology , pituitary adenoma , adenoma , ophthalmology , disease , growth hormone , hormone
Summary Objective To investigate the long‐term outcome of fractionated stereotactic radiotherapy (FSRT) [45 Gy (range 45–54) in 25 fractions] in patients with pituitary adenomas characterized by tumour progression or hormonally active disease despite surgery and/or medical therapy. Design This was an observational follow‐up study of 5·25 years (median; range 1·7–10·4). Patients and measurements Pituitary tumour volume, visual acuity/fields, hypersecretion, hypopituitarism, cerebrovascular disease, second brain tumours and mortality were examined at regular intervals after FSRT in 30 patients with pituitary adenomas (20 nonfunctioning macroadenomas, 10 functioning). Prior to FSRT, 83% had been operated 1–3 times, 47% had visual field deficits/impaired vision and 50% pituitary dysfunction. Progressive disease, stable disease, partial and complete tumour response were defined by MRI. Results Tumour growth control was 100%. At the end of follow‐up, 30% had stable disease, 60% partial and 10% complete tumour response. Visual function was preserved and 36% of patients with prior field deficits improved. GH decreased from 4·2 (range, 2·3–6·5) to 1·1 (range, 0·5–1·5) μg/l ( P < 0·001) in patients with acromegaly, and medical therapy could be reduced. In large prolactinomas, partial response or complete tumour response was achieved. FSRT was well tolerated. Pituitary function remained normal in 27%, 33% of patients had stable dysfunction, 17% deteriorated further and 23% developed new dysfunction. There were no cerebrovascular events, second brain tumours or FSRT‐related deaths. Conclusion According to this long‐term follow‐up study, FSRT is an efficient and safe adjuvant therapy for pituitary adenomas refractory to conventional treatments.