Gamma surgery in the treatment of nonsecretory pituitary macroadenoma.
OBJECTIVE
The authors report on a retrospective analysis of the imaging and clinical outcomes following gamma surgery in 100 patients with nonsecretory pituitary macroadenoma.


METHODS
Between June 1989 and March 2004, 100 consecutive patients with nonsecretory pituitary macroadenoma were treated at the Lars Leksell Center for Gamma Surgery, University of Virginia Health System (Charlottesville, VA). Ninety-two patients had residual or recurrent macroadenoma following one or more surgical procedures. In eight patients, gamma surgery was the primary treatment. Ten patients received conventional fractionated radiotherapy before the gamma surgery. Sixty-nine patients required hormone replacement therapy for one or more deficits before gamma knife treatment. Peripheral doses between 5 and 25 Gy (mean 18.5 Gy) were administered. Imaging and endocrinological follow-up evaluations were performed in 90 patients; these studies ranged from 6 to 142 months (mean 44.9 months) and 6 to 127 months (mean 47.9 months), respectively. Tumor volume decreased in 59 patients (65.6%), remained unchanged in 24 (26.7%), and increased in seven (7.8%). The minimal effective peripheral dose was 12 Gy; peripheral doses greater than 20 Gy did not seem to provide additional benefit. Of 61 patients with a partially or fully functioning pituitary gland and follow-up data, 12 (19.7%) suffered new hormone deficits following gamma surgery. In patients with endocrinological follow-up data that had been collected over more than 2 years, the rate of new deficits was 25%. No neurological morbidity or death was related to treatment.


CONCLUSIONS
Current experience suggests that gamma surgery is an appropriate means of managing recurrent or residual nonsecretory pituitary macroadenoma following microsurgery and a primary treatment in selected patients. To evaluate definite rates of recurrence and new endocrine deficiencies, long-term follow-up studies are needed.
Mingione
Vincenzo
V
Department of Neurological Surgery, Lars Leksell Center for Gamma Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Yen
Chun Po
CP
Vance
Mary Lee
ML
Steiner
Melita
M
Sheehan
Jason
J
Laws
Edward R
ER
Steiner
Ladislau
L
D000236:Adenoma / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000097:blood; D010911:Pituitary Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
D010907:Pituitary Hormones