title: The role of radiosurgery for the treatment of pineal parenchymal tumors.
abstract: OBJECTIVE
  Radiosurgery is an appealing alternative management strategy for selected patients with biopsy-proved pineal parenchymal tumors. The purpose of this report was to clarify its role in conjunction with other surgical, radiation, and medical approaches.
  
  
  METHODS
  We retrospectively evaluated 16 patients who had undergone radiosurgery as the primary or adjuvant treatment for pineal parenchymal tumors. Ten patients (62.5%) had pineocytomas, two (12.5%) had mixed pineocytoma and pineoblastoma, and four (25%) had pineoblastomas. The mean marginal dose was 15 Gy, and the mean tumor volume was 5.0 cm(3). The mean follow-up periods from the time of diagnosis or the time of radiosurgery were 61 and 52 months, respectively.
  
  
  RESULTS
  The overall actuarial 2- and 5-year survival rates after diagnosis were 75.0 and 66.7%, respectively. In 14 patients who were evaluated with imaging, 4 (29%) demonstrated complete remission, 8 (57%) had partial remission, 2 (14%) had no change, and no patient had local progression. The local tumor control rate (complete remission, partial remission, or no change) was 100%. Five patients died during follow-up. One patient with a pineocytoma and three patients with pineoblastomas died secondary to leptomeningeal or extracranial spread tumor. No cause of death was established for one patient. Two patients developed adverse radiation effects after radiosurgery.
  
  
  CONCLUSIONS
  Our initial experience suggests that stereotactic radiosurgery is a valuable primary management modality for patients with pineocytomas. As adjuvant therapy, radiosurgery may be used to boost local tumor dose during multimodality management of malignant pineal parenchymal tumors.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: Constantinos G
authors.initials: CG
authors.lastname: Hadjipanayis
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010870:Pineal Gland; D010871:Pinealoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome