Overall and progression-free survival and visual and endocrine outcomes for patients with parasellar lesions treated with intensity-modulated stereotactic radiosurgery.
Linear accelerator single-fraction radiosurgery (SRS) for skull base lesions is usually delivered with dynamic conformal arcs (DCAs), but intensity-modulated radiosurgery (IMRS) is another option when SRS dose is limited by proximity of the optic nerve and chiasm. We review the long-term outcome of patients treated with IMRS for parasellar lesions. Fourteen patients with parasellar lesions were treated with IMRS when standard DCA radiosurgery was limited by optic nerve tolerance. Prospective patient data included endocrine function, visual acuity and field testing, nonoptic nerve cranial neuropathy, and overall survival. In addition, tumor control on serial magnetic resonance imaging is reported as progression-free survival (PFS). Six patients with cavernous sinus meningiomas and eight with recurrent pituitary adenomas were treated. Three of the pituitary tumors were hormonally active (two with Cushing disease, one with acromegaly). The median patient age was 50 years (range 24-70 years). Median follow-up was 54 months. Average tumor treatment volume was 4.99 ml (average dose 16 Gy, average of 10 IMRS fields). Tumor control was achieved in 11 of 14 (79%) patients. Median PFS has not been reached in our patient population. Thirteen patients are alive (one died of an unrelated cancer). No patients developed new endocrinological, ophthalmological, or cranial nerve deficits. IMRS allows for treatment of parasellar lesions when standard DCA SRS is limited by optic nerve tolerance. Although our follow-up period was relatively short and the number of patients was small, it appears that this can be accomplished with a high tumor control rate and survival without new endocrinopathies, optic neuropathies, or other complications in patients who have failed other therapies.
Jensen
Randy L
RL
Department of Neurosurgery, Huntsman Cancer Institute, University of Utah Health Sciences Center, 5th Floor, Clinical Neurosciences Center, 175 North Medical Drive, Salt Lake City, UT, 84132, USA. randy.jensen@hsc.utah.edu
Jensen
Peter R
PR
Shrieve
Annabelle F
AF
Hazard
Lisa
L
Shrieve
Dennis C
DC
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004700:Endocrine System Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology*; D055815:Young Adult
Int J Radiat Oncol Biol Phys. 2003 Jan 1;55(1):99-109
12504041
J Neurooncol. 2009 May;92(3):345-56
19357961
Strahlenther Onkol. 2005 May;181(5):336-44
15900431
Stereotact Funct Neurosurg. 2008;86(5):292-6
18758206
Int J Radiat Oncol Biol Phys. 1994 Nov 15;30(4):755-63
7960976
Int J Radiat Oncol Biol Phys. 2001 Apr 1;49(5):1481-91
11286857
Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):580-92
12957272
Int J Radiat Oncol Biol Phys. 2002 Jul 15;53(4):987-91
12095567
J Neurosurg. 1998 Jan;88(1):43-50
9420071
Prog Neurol Surg. 2009;22:77-95
18948721
Int J Radiat Oncol Biol Phys. 2003 Jul 1;56(3):801-6
12788188
Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1337-45
10889388
Neurosurgery. 2009 Feb;64(2 Suppl):A19-25
19165069
Clin Oncol (R Coll Radiol). 2009 Jun;21(5):408-16
19268555
J Neurosurg. 2000 Dec;93 Suppl 3:219-22
11143252
Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):607-14
1907958
Otolaryngol Clin North Am. 2009 Aug;42(4):601-21
19751867
Radiology. 1976 Jul;120(1):167-71
935443
Important Adv Oncol. 1995;:141-56
7672802
Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):437-44
9308948
J Med Assoc Thai. 2009 Mar;92(3):382-9
19301733
Int J Radiat Oncol Biol Phys. 2001 Dec 1;51(5):1313-9
11728692
Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):215-21
8407394
Neurosurg Clin N Am. 2000 Oct;11(4):575-86
11082168
Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1177-81
12654424
Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1265-70
12128128
Neurosurg Clin N Am. 2006 Apr;17(2):67-78, v
16793500
Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1018-26
19217219
Med Dosim. 2003 Summer;28(2):85-90
12804705
Rev Endocr Metab Disord. 2009 Jun;10(2):135-44
18787957
J Neurosurg. 1994 Feb;80(2):195-201
8283256
Neurosurgery. 1998 Mar;42(3):446-53; discussion 453-4
9526976
Neurosurgery. 2008 May;62(5 Suppl):A2-9; discussion A9-10
18580777
Med Dosim. 2001 Summer;26(2):143-50
11444516