title: LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results.
abstract: OBJECTIVE
  Stereotactic linear accelerator-based radiosurgery (LINAC-RS) is increasingly used for microsurgically inaccessible or recurrent pituitary adenomas. This single-center study evaluates the long-term follow-up after LINAC-RS of nonsecreting pituitary adenomas (NSA).
  
  
  METHODS
  Between 1992 and August 2008, 65 patients with NSA were treated. Patient treatment and follow-up were conducted according to a prospective protocol. Indications for LINAC-RS were (1) tumor recurrence or (2) residual tumor. Three patients were treated primarily. For analysis of prognostic factors, patients were grouped according to epidemiological or treatment-associated characteristics.
  
  
  RESULTS
  A total of 61 patients with a follow-up ≥ 12 months (median 83 months, range 15-186 months, longest follow-up of published radiosurgery series) were evaluated with regard to their clinical, radiological, and endocrinological course. The median tumor volume was 3.5 ml (± 4.3 ml, range 0.3-17.3 ml) treated with a median surface and maximum dose of 13.0 Gy and 29.7 Gy, respectively. Local tumor control was achieved in 98%. One patient died of unrelated cause after 36 months and 1 patient developed a radiation-induced seizure disorder. Visual complications did not occur. In 37 of 41 patients (90.2%), pituitary function remained stable. Maximum dose to the pituitary ≤ 16 Gy and female gender were positive prognostic factors for the preservation of pituitary function.
  
  
  CONCLUSIONS
  LINAC-RS is a minimally invasive, safe, and effective treatment for recurrent NSA or microsurgically inaccessible residual tumor. LINAC-RS yielded a high rate of local long-term tumor control with a small number of radiation-induced side effects.
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital, Cologne, Kerpener Str. 62, 50937, Cologne, Germany. matthias.runge@uk-koeln.de
authors.forename: M J R
authors.initials: MJ
authors.lastname: Runge
authors.forename: M
authors.initials: M
authors.lastname: Maarouf
authors.forename: S
authors.initials: S
authors.lastname: Hunsche
authors.forename: M
authors.initials: M
authors.lastname: Kocher
authors.forename: M I
authors.initials: MI
authors.lastname: Ruge
authors.forename: F
authors.initials: F
authors.lastname: El Majdoub
authors.forename: H
authors.initials: H
authors.lastname: Treuer
authors.forename: R-P
authors.initials: RP
authors.lastname: Mueller
authors.forename: J
authors.initials: J
authors.lastname: Voges
authors.forename: V
authors.initials: V
authors.lastname: Sturm
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery*; D058958:Organs at Risk; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D012086:Reoperation; D055815:Young Adult