Gamma Knife radiosurgery in pituitary adenomas: Why, who, and how to treat?
Pituitary adenomas are benign tumors that can be either secreting (acromegaly, Cushing's disease, prolactinomas) or non-secreting. Transsphenoidal neurosurgery is the gold standard treatment; however, it is not always effective. Gamma Knife radiosurgery is a specific modality of stereotactic radiosurgery, a precise radiation technique. Several studies reported the efficacy and low risk of adverse effects induced by this technique: in secreting pituitary adenomas, hypersecretion is controlled in about 50% of cases and tumor volume is stabilized or decreased in 80-90% of cases, making Gamma Knife a valuable adjunctive or first-line treatment. As hormone levels decrease progressively, the main drawback is the longer time to remission (12-60 months), requiring an additional treatment during this period. Hypopituitarism is the main side effect, observed in 20-40% cases. Gamma Knife is thus useful in the therapeutic algorithms of pituitary adenomas in well-defined indications, mainly low secreting small lesions well identified on magnetic resonance imaging (MRI).
Castinetti
Frederic
F
Department of Endocrinology, La Timone Hospital, Marseille, France. castinetti@univmed.fr
Brue
Thierry
T
D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D010911:Pituitary Neoplasms / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*