scholarly journals Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4998
Author(s):  
Luigi Albano ◽  
Marco Losa ◽  
Lina Raffaella Barzaghi ◽  
Ajay Niranjan ◽  
Zaid Siddiqui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Tumors ◽  
Progression Free Survival ◽  
Pooled Analysis ◽  
Tumor Control ◽  
Acth Secreting

To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89–97%) and 95% (95% CI 91–99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35–54%) for GH-secreting adenomas, 64% (95% CI 0.52–0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19–48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67–81%) and 70% (95% CI: 64–76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.

scholarly journals C.04 A systematic review and meta-analysis of 7551 patients with post-operative radiation for the management of functioning and non-functioning pituitary adenomas

2018 ◽  
Vol 45 (s2) ◽  
pp. S14-S14
Author(s):  
OH Khan ◽  
N Samuel ◽  
N Alotaibi
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Publication Date ◽  
Significant Heterogeneity ◽  
Free Survival

Background: Although surgery is the mainstay of treatment for most pituitary adenomas, post-operative radiotherapy has been shown to be of benefit in improving tumor control and recurrence-free survival. To understand potential side effects of radiotherapy we performed a systematic review and meta-analysis to determine the efficacy and safety of post-operative radiotherapy for pituitary adenoma. Methods: A systematic review was performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We searched PubMed, MEDLINE and Cochrane databases with no language or publication date restrictions. Outcomes included 5- and 10-year progression-free survival and adverse events rates. Results: A total of 48 studies from 1986-2016 met the inclusion criteria, with 7551 cumulative patients. The cumulative 5- and 10-year s progression-free survival rates were 90.8% (95% CI 86-94%) and 88.6% (95% CI 81-93%), respectively. The overall adverse events rate was 8% (95% CI 5-12%). All outcomes were associated with significant heterogeneity (I2 ≥ 70%). No differences in survival rates or adverse events in relation to study date, tumor pathology, radiosurgery system used or dose of radiation. Conclusions: Post-operative radiotherapy for pituitary adenomas is effective and safe. Because of the significant heterogeneity and lack of matched controls in the literature, optimum timing and dosage are still unclear. Further prospective studies are needed.

scholarly journals Characteristic of Tumor Regrowth After Gamma Knife Radiosurgery and Outcomes of Repeat Gamma Knife Radiosurgery in Nonfunctioning Pituitary Adenomas

2021 ◽  
Vol 11 ◽  
Author(s):  
Yanli Li ◽  
Lisha Wu ◽  
Tingting Quan ◽  
Junyi Fu ◽  
Linhui Cao ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Key Management ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Nonfunctioning Pituitary Adenomas ◽  
Independent Risk Factors ◽  
Tumor Regrowth ◽  
Design And Methods

ObjectiveThis study aimed to report the characteristic of tumor regrowth after gamma knife radiosurgery (GKRS) and outcomes of repeat GKRS in nonfunctioning pituitary adenomas (NFPAs).Design and MethodsThis retrospective study consisted of 369 NFPA patients treated with GKRS. The median age was 45.2 (range, 7.2–84.0) years. The median tumor volume was 3.5 (range, 0.1–44.3) cm3.ResultsTwenty-four patients (6.5%) were confirmed as regrowth after GKRS. The regrowth-free survivals were 100%, 98%, 97%, 86% and 77% at 1, 3, 5, 10 and 15 year, respectively. In multivariate analysis, parasellar invasion and margin dose (<12 Gy) were associated with tumor regrowth (hazard ratio [HR] = 3.125, 95% confidence interval [CI] = 1.318–7.410, p = 0.010 and HR = 3.359, 95% CI = 1.347–8.379, p = 0.009, respectively). The median time of regrowth was 86.1 (range, 23.2–236.0) months. Previous surgery was associated with tumor regrowth out of field (p = 0.033). Twelve patients underwent repeat GKRS, including regrowth in (n = 8) and out of field (n = 4). Tumor shrunk in seven patients (58.3%), remained stable in one (8.3%) and regrowth in four (33.3%) with a median repeat GKRS margin dose of 12 (range, 10.0–14.0) Gy. The actuarial tumor control rates were 100%, 90%, 90%, 68%, and 68% at 1, 3, 5, 10, and 15 years after repeat GKRS, respectively.ConclusionsParasellar invasion and tumor margin dose (<12 Gy) were independent risk factors for tumor regrowth after GKRS. Repeat GKRS might be effective on tumor control for selected patients. For regrowth in field due to relatively insufficient radiation dose, repeat GKRS might offer satisfactory tumor control. For regrowth out of field, preventing regrowth out of field was the key management. Sufficient target coverage and close follow-up might be helpful.

scholarly journals P03.07 Radiosurgical managementof trigeminal schwannomas: A single center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
W A Reda ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Target Volume ◽  
Primary Treatment ◽  
Tumor Control ◽  
Single Center Experience ◽  
Primary Treatment Modality ◽  
The Mean

Abstract BACKGROUND Trigeminal schwannomas are a rare form of intracranial schwannomas. They can occur anywhere along the track of the trigeminal nerve, including the middle, posterior fossa or both. It can even extend extracranially. The variability of its location and extent, in addition to its close proximity to critical neurovascular structures makes surgical intervention challenging. Taking from the success of treating vestibular schwannomas with stereotactic radiosurgery, it has been used as an alternative to surgery for the treatment of trigeminal schwannomas. Because these tumors are rare more clinical evidence is required to assess the response of these tumors to stereotactic radiosurgery.The aim of this study was to evaluate the efficacy and complications associated with treatment of the trigeminal schwannomas by gamma knife radiosurgery. MATERIAL AND METHODS The study included 51 patients with trigeminal schwannomas not associated with NF2, treated by Leksell gamma knife. There were 25 males and 26 females. The mean age at presentation was 43 years. The patients underwent a total of 58 gamma knife sessions (44 single and 7 volume-staged sessions). Eight patients had previous surgery. The tumor nature was solid in 46, cystic in 3 and mixed in 2 patients. The mean target volume was 8.5 cc (0.6–30.7 cc) with the mean overall tumor volume being 9.6 cc (0.6–31.1 cc). The mean prescription dose was 12 Gy. RESULTS The mean follow up was 57 months (12–152 months). The tumor shrank in 23 (45%) patients and remained stable in 25 (49%). Tumor progressions occurred in 3 (6%) patients. The tumor control rate was 92%. The progression-free survival at 5,7 and 10 years was 95%, 88% and 79%, respectively. Clinical improvement occurred in 27 (53%) patients and was significantly associated with tumor shrinkage (p 0.03). Twenty patients (39%) remained clinically unchanged. Adverse radiation events occurred in 7 patients and were significantly associated with target and overall tumor volume (p 0.028 and 0.004). CONCLUSION Gamma knife radiosurgery appears to be an effective and safe adjuvant and primary treatment modality for trigeminal schwannomas. Large tumors should be debulked first before radiosurgery, when feasible.

Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis

2020 ◽  
Vol 21 (11) ◽  
pp. 1526-1536
Author(s):  
Tariq Parker ◽  
Grant Rigney ◽  
Justiss Kallos ◽  
S Tonya Stefko ◽  
Hideyuki Kano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gamma Knife ◽  
Meta Analysis ◽  
Gamma Knife Radiosurgery ◽  
Uveal Melanomas

scholarly journals Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

2015 ◽  
Vol 123 (5) ◽  
pp. 1287-1293 ◽  
Author(s):  
Jason P. Sheehan ◽  
Cheng-Chia Lee ◽  
Zhiyuan Xu ◽  
Colin J. Przybylowski ◽  
Patrick D. Melmer ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
High Rate ◽  
Tumor Control ◽  
Peritumoral Edema ◽  
Who Grade ◽  
Increased Risk

OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma

2002 ◽  
Vol 97 ◽  
pp. 408-414 ◽  
Author(s):  
Jason P. Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Visual Fields ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas ◽  
Fine Print

Object. Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. Methods. A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. Conclusions. Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

scholarly journals Immune-Related Adverse Events Associated With Outcomes in Patients With NSCLC Treated With Anti-PD-1 Inhibitors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhe Zhao ◽  
Xinfeng Wang ◽  
Jinghan Qu ◽  
Wei Zuo ◽  
Yan Tang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Objective Response ◽  
Progression Free Survival ◽  
Predictive Biomarker ◽  
Pooled Analysis ◽  
Conclusive Evidence ◽  
Risk Of Death

Background and ObjectiveAlthough anti-programmed cell death protein 1 (PD-1) antibodies have exerted remarkable anticancer activity in non-small cell lung cancer (NSCLC), it remains a challenge to identify patients who can benefit from these treatments. Immune-related adverse events (irAEs) may be associated with improved clinical outcomes after immune checkpoint inhibition. However, no conclusive evidence of this correlation has been summarized in patients with NSCLC receiving PD-1 inhibitors. We performed a systematic review and meta-analysis to evaluate the association between irAEs induced by anti-PD-1 antibodies and clinical outcomes in patients with NSCLC.MethodsVarious databases were searched from their inception to January 9, 2021, followed by screening of eligible studies. Hazard ratios were used for the pooled analysis of overall survival (OS) and progression-free survival (PFS), while odds ratios (ORs) were utilized to pool objective response rates (ORRs) and disease control rates (DCRs). A random-effects model was applied to all analyses.ResultsA total of 26 cohorts, including 8,452 patients with NSCLC receiving anti-PD-1 antibodies, were enrolled in the study. Significantly improved OS (HR: 0.51; 95% CI: 0.44-0.60; P &lt; 0.01) and PFS (HR: 0.50; 95% CI: 0.43-0.58; P &lt; 0.01) were found to be correlated with irAEs. In addition, patients with NSCLC who developed irAEs after PD-1 inhibition demonstrated better responses to therapies, confirmed by pooled ORs of ORRs (OR: 3.41; 95% CI: 2.66-4.35; P &lt; 0.01) and DCRs (OR: 4.08; 95% CI: 2.30-7.24; P &lt; 0.01). Furthermore, subgroup analysis suggested that both skin and endocrine irAEs are closely correlated with a reduced risk of death, whereas pulmonary irAEs showed no association with longer OS.ConclusionsIn patients with NSCLC treated with anti-PD-1 therapies, the presence of irAEs was strongly correlated with better survival and response, suggesting its potential role as a predictive biomarker for outcomes after PD-1 inhibition.

scholarly journals Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

2014 ◽  
Vol 120 (3) ◽  
pp. 647-654 ◽  
Author(s):  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Huai-Che Yang ◽  
Zhiyuan Xu ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Outcome Data ◽  
Tumor Control ◽  
Surgical Removal ◽  
Tumor Margin ◽  
Tumor Control Rate ◽  
Nonfunctioning Pituitary Adenomas

Object Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management. Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In this report, the authors evaluated the efficacy and safety of initial GKRS for NFAs. Methods An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs. Results Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2–25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025). Conclusions In this study, GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma.

Radiosurgery for nonfunctioning pituitary adenoma

2003 ◽  
Vol 14 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Jason P. Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Treatment Modality ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Primary Treatment ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas ◽  
Primary Treatment Modality

Object Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study was to evaluate the efficacy and role of gamma knife surgery (GKS) in the treatment of these lesions. Methods The authors conducted a review of cases in which GKS was performed at the University of Pittsburgh between 1987 and 2001. Forty-six patients with nonfunctioning pituitary adenomas and with at least 6 months of follow-up data were identified. In 41 of these patients some form of prior treatment such as transsphenoidal resection, craniotomy and resection, or conventional radiation therapy had been conducted. Five patients were deemed ineligible for microsurgery, and GKS served as the primary treatment modality. Endocrinological, ophthalmological, and radiological responses were evaluated. The mean radiation dose to the margin was 16 Gy. In all patients with microadenomas and 91% of those with macroadenomas tumor control was demonstrated after radiosurgery. Gamma knife surgery had essentially equal efficacy in terms of achieving tumor control in cases of adenomas with cavernous sinus invasion and suprasellar extension. No new endocrinopathies were noted following radiosurgery. In two patients, however, tumor growth and decline in visual function occurred. Conclusions Gamma knife surgery is safe and effective in treating nonfunctioning pituitary adenomas. Radiosurgery may serve as a primary treatment modality in some or as a salvage treatment in others. Treatment must be tailored to meet the patient's symptoms, overall health, and tumor morphometry.

scholarly journals Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis

2019 ◽  
Vol 46 (6) ◽  
pp. E2 ◽  
Author(s):  
Nida Fatima ◽  
Antonio Meola ◽  
Erqi L. Pollom ◽  
Scott G. Soltys ◽  
Steven D. Chang
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Tumor Control ◽  
Case Control Studies ◽  
Intracranial Meningiomas

OBJECTIVEStereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been used as a primary treatment or adjuvant to resection in the management of intracranial meningiomas (ICMs). The aim of this analysis is to compare the safety and long-term efficacy of SRS and SRT in patients with primary or recurrent ICMs.METHODSA systematic review of the literature comparing SRT and SRS in the same study was conducted using PubMed, the Cochrane Library, Google Scholar, and EMBASE from January 1980 to December 2018. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS versus SRT for the treatment of ICMs in adult patients (age > 16 years) were included. Pooled and subgroup analyses were based on the fixed-effect model.RESULTSA total of 1736 patients from 12 retrospective studies were included. The treatment modality used was: 1) SRS (n = 306), including Gamma Knife surgery (n = 36), linear accelerator (n = 261), and CyberKnife (n = 9); or 2) SRT (n = 1430), including hypofractionated SRT (hFSRT, n = 268) and full-fractionated SRT (FSRT, n = 1162). The median age of patients at the time of treatment was 59 years. The median follow-up duration after treatment was 35.5 months. The median tumor volumes at the time of treatment with SRS, hFSRT, and FSRT were 2.84 cm3, 5.45 cm3, and 12.75 cm3, respectively. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27–0.82, p = 0.007) with 7% less volume of tumor shrinkage (OR 0.93, 95% CI 0.61–1.40, p = 0.72). Compared to SRS, the radiographic tumor control was better achieved by FSRT (OR 0.46, 95% CI 0.26–0.80, p = 0.006) than by hFSRT (OR 0.81, 95% CI 0.21–3.17, p = 0.76). Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up (OR 2.07, 95% CI 1.06–4.06, p = 0.03) and of immediate symptomatic edema (OR 4.58, 95% CI 1.67–12.56, p = 0.003) with respect to SRT. SRT could produce a better progression-free survival at 4–10 years compared to SRS, but this was not statistically significant (p = 0.29).CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results.

Sign in / Sign up

Export Citation Format

Share Document