title: Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes.
abstract: OBJECTIVE
  Gamma Knife surgery (GKS) is a common treatment for recurrent or residual pituitary adenomas. This study evaluates a large cohort of patients with a pituitary adenoma to characterize factors related to endocrine remission, control of tumor growth, and development of pituitary deficiency.
  
  
  METHODS
  A total of 418 patients who underwent GKS with a minimum follow-up of 6 months (median 31 months) and for whom there was complete follow-up were evaluated. Statistical analysis was performed to evaluate for significant factors (p < 0.05) related to treatment outcomes.
  
  
  RESULTS
  In patients with a secretory pituitary adenoma, the median time to endocrine remission was 48.9 months. The tumor margin radiation dose was inversely correlated with time to endocrine remission. Smaller adenoma volume correlated with improved endocrine remission in those with secretory adenomas. Cessation of pituitary suppressive medications at the time of GKS had a trend toward statistical significance in regard to influencing endocrine remission. In 90.3% of patients there was tumor control. A higher margin radiation dose significantly affected control of adenoma growth. New onset of a pituitary hormone deficiency following GKS was seen in 24.4% of patients. Treatment with pituitary hormone suppressive medication at the time of GKS, a prior craniotomy, and larger adenoma volume at the time of radiosurgery were significantly related to loss of pituitary function.
  
  
  CONCLUSIONS
  Smaller adenoma volume improves the probability of endocrine remission and lowers the risk of new pituitary hormone deficiency with GKS. A higher margin dose offers a greater chance of endocrine remission and control of tumor growth.
authors.affiliation: Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. jps2f@virginia.edu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
authors.forename: Nader
authors.initials: N
authors.lastname: Pouratian
authors.forename: Ladislau
authors.initials: L
authors.lastname: Steiner
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Vance
mesh_terms: D000172:Acromegaly / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010911:Pituitary Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D016634:Radiosurgery / Q000295:instrumentation*; D016896:Treatment Outcome