Treatment of Nonfunctional Pituitary Adenoma Postoperative Remnants: Adjuvant or Delayed Gamma Knife Radiosurgery?

• Published in: World neurosurgery 2017-04, Vol.100, p.361-368
• Main Authors: Sadik, Z.H.A., Voormolen, E.H.J., Depauw, P.R.A.M., Burhani, B., Nieuwlaat, W.A., Verheul, J., Leenstra, S., Fleischeuer, R., Hanssens, P.E.J.
• Format: Article
• Language: English
• Subjects: Adenoma - diagnosis; Adenoma - radiotherapy; Adult; Aged; Female; Follow-Up Studies; Gamma Knife Radiosurgery; Humans; Macroadenoma; Male; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - radiotherapy; Nonfunctional pituitary adenoma; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - radiotherapy; Pituitary surgery; Postoperative Care - methods; Postoperative Care - trends; Radiosurgery - methods; Radiosurgery - trends; Radiotherapy, Adjuvant; Retrospective Studies
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.01.028

It is still not clear whether Gamma Knife radiosurgery (GKRS) for nonfunctional pituitary adenomas should be used as a standard adjuvant postoperative therapy or applied when there is documented progression of the remnant on follow-up magnetic resonance imaging. We performed a retrospective study of patients with nonfunctional pituitary adenomas who underwent primary surgery and GKRS between 2002 and 2015. Patients were divided into 2 groups on the basis of the GKRS indication: adjuvant treatment (GKRS ≤6 months postoperatively) or delayed treatment (GKRS if documented progression occurred on the follow-up magnetic resonance imaging). Fifty patients were included and grouped based on adjuvant (n = 13) or delayed (n = 37) GKRS following primary surgery. The adjuvant and delayed groups had 10-year actuarial tumor control rates of 92% and 96% (P = 0.408), respectively. The 10-year actuarial endocrinologic control rate was 82% for the adjuvant group and 49% for the delayed group (P = 0.597). None of the patients developed any new neurologic deficit post-GKRS. GKRS-induced complications (intratumoral bleeding and tumoral tissue inflammation) occurred in 6% of the patients, of whom 4% were in the delayed group and 2% in the adjuvant group. Adjuvant treatment with GKRS yields the same high long-term tumor control as delayed GKRS. Neither adjuvant nor delayed GKRS induced additional neurologic complications. There is a trend that adjuvant GKRS induces less additional endocrinologic deficits compared with delayed GKRS.