Stereotactic radiosurgery for pituitary metastases.
BACKGROUND
We evaluated the role of Gamma Knife SRS in the multidisciplinary management of metastatic cancer to the pituitary gland.


METHODS
We retrospectively reviewed records of 18 consecutive pituitary metastasis patients who underwent Gamma Knife SRS during a 21-year experience. The median patient age was 57.6 years (range, 27.0-81.1 years). There were 5 patients who had initial surgical resection of their pituitary metastasis, 5 who had fractionated radiation, and 7 who had CT before SRS. The median radiosurgery target volume was 3.5 mL (range, 0.2-18.0 mL), and the median marginal dose was 13.0 Gy (range, 9-18 Gy).


RESULTS
The overall survival after SRS at 3, 6, and 12 months, respectively, was 66%, 36%, and 18%. The median survival after SRS was 5.2 months. The progression-free survival after SRS was 100% and 66.7% at 6 and 12 months, respectively. The only factor associated with an improved overall survival was younger age at presentation. Diabetes insipidus improved in 3 (42.9%) of 7 patients. Neurological symptoms or signs improved in 4 (50.0%) of 8 patients. Three (16.7%) patients developed new neurological deficits due to tumor progression despite SRS.


CONCLUSIONS
Development of a pituitary metastasis is an ominous finding in the context of systemic cancer. Stereotactic radiosurgery is an effective palliative approach for most patients with pituitary metastasis.
Kano
Hideyuki
H
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Niranjan
Ajay
A
Kondziolka
Douglas
D
Flickinger
John C
JC
Lunsford
L Dade
LD
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery; D003919:Diabetes Insipidus / Q000209:etiology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005720:Gamma Rays; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010911:Pituitary Neoplasms / Q000150:complications / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome