Postoperative Gamma Knife Radiosurgery for Cavernous Sinus–Invading Growth Hormone–Secreting Pituitary Adenomas

Eui Hyun Kim, Min Chul Oh, Jong Hee Chang, Ju Hyung Moon, Cheol Ryong Ku, Won Seok Chang, Eun Jig Lee, Sun Ho Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects. Methods: Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations. Results: The mean tumor volume and margin dose irradiated by GKS was 3.7 cm3 and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes. Conclusions: GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.

Original languageEnglish
Pages (from-to)e534-e545
JournalWorld Neurosurgery
Volume110
DOIs
Publication statusPublished - 2018 Feb

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Radiosurgery
Pituitary Neoplasms
Cavernous Sinus
Growth
Neoplasms
Hypopituitarism
Radiation
Necrosis
Acromegaly
Glucose Tolerance Test
Tumor Burden

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kim, E. H., Oh, M. C., Chang, J. H., Moon, J. H., Ku, C. R., Chang, W. S., ... Kim, S. H. (2018). Postoperative Gamma Knife Radiosurgery for Cavernous Sinus–Invading Growth Hormone–Secreting Pituitary Adenomas. World Neurosurgery, 110, e534-e545. https://doi.org/10.1016/j.wneu.2017.11.043
Kim, Eui Hyun ; Oh, Min Chul ; Chang, Jong Hee ; Moon, Ju Hyung ; Ku, Cheol Ryong ; Chang, Won Seok ; Lee, Eun Jig ; Kim, Sun Ho. / Postoperative Gamma Knife Radiosurgery for Cavernous Sinus–Invading Growth Hormone–Secreting Pituitary Adenomas. In: World Neurosurgery. 2018 ; Vol. 110. pp. e534-e545.
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abstract = "Objective: We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects. Methods: Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations. Results: The mean tumor volume and margin dose irradiated by GKS was 3.7 cm3 and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1{\%}, 43.6{\%}, and 65.6{\%}, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes. Conclusions: GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.",
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Postoperative Gamma Knife Radiosurgery for Cavernous Sinus–Invading Growth Hormone–Secreting Pituitary Adenomas. / Kim, Eui Hyun; Oh, Min Chul; Chang, Jong Hee; Moon, Ju Hyung; Ku, Cheol Ryong; Chang, Won Seok; Lee, Eun Jig; Kim, Sun Ho.

In: World Neurosurgery, Vol. 110, 02.2018, p. e534-e545.

Research output: Contribution to journalArticle

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T1 - Postoperative Gamma Knife Radiosurgery for Cavernous Sinus–Invading Growth Hormone–Secreting Pituitary Adenomas

AU - Kim, Eui Hyun

AU - Oh, Min Chul

AU - Chang, Jong Hee

AU - Moon, Ju Hyung

AU - Ku, Cheol Ryong

AU - Chang, Won Seok

AU - Lee, Eun Jig

AU - Kim, Sun Ho

PY - 2018/2

Y1 - 2018/2

N2 - Objective: We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects. Methods: Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations. Results: The mean tumor volume and margin dose irradiated by GKS was 3.7 cm3 and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes. Conclusions: GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.

AB - Objective: We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects. Methods: Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations. Results: The mean tumor volume and margin dose irradiated by GKS was 3.7 cm3 and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes. Conclusions: GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.

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