Treatment of Non-Functional Pituitary Adenoma Post-Operative Remnants: Adjuvant or Delayed Gamma Knife Radiosurgery?

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Treatment of Non-Functional Pituitary Adenoma Post-Operative Remnants: Adjuvant or Delayed Gamma Knife Radiosurgery?

World Neurosurg. 2017 Jan 17;:

Authors: Sadik ZH, Voormolen EH, Depauw PR, Burhani B, Nieuwlaat WA, Verheul J, Leenstra S, Fleischeuer R, Hanssens PE

Abstract
OBJECTIVE: It is still not clear whether Gamma knife Radiosurgery (GKRS) for non-functional pituitary adenomas (NFPA) should be used as a standard adjuvant postoperative therapy or applied when there is documented progression of the remnant on the follow-up (FU) MRI.
METHODS: We performed a retrospective study of patients with non-functional pituitary adenomas who underwent primary surgery and GKRS between 2002 and 2015. Patients were divided into two groups based on the GKRS indication: adjuvant treatment (GKRS ≤6 months postoperatively) or delayed treatment (GKRS if documented progression occurred on the FU MRI).
RESULTS: Fifty patients where included and grouped based on adjuvant (n=13) or delayed (n=37) GKRS following primary surgery. The adjuvant and delayed group had a 10-years actuarial tumor control rate of 92% and 96% (p=0.408), respectively. The 10-years actuarial endocrinological control rate was 82% for the adjuvant group and 49% for the delayed group (p=0.597). None of the patients developed any new neurological deficit post-GKRS. GKRS-induced complications (intra-tumoral bleeding and tumoral tissue inflammation) occurred in 6% of the patients of whom 4% were in the delayed group and 2% in the adjuvant group.
CONCLUSION: Adjuvant treatment with GKRS yields the same high long-term tumor control as delayed GKRS. Neither adjuvant nor delayed GKRS induced additional neurological complications. There is a trend that adjuvant GKRS induces less additional endocrinological deficits compared with delayed GKRS.

PMID: 28108427 [PubMed - as supplied by publisher]

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