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  • Review Article
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Role of stereotactic radiosurgery in the management of pituitary adenomas

Nature Reviews Endocrinology volume 6, pages 214–223 (2010)Cite this article

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Abstract

Trans-sphenoidal neurosurgery is the gold standard treatment for pituitary adenomas, but it can be contraindicated or ineffective. Stereotactic radiosurgery is a procedure aimed at controlling hormone hypersecretion and tumor size of pituitary adenomas. This Review discusses the long-term efficacy and adverse effects of stereotactic radiosurgery with the Gamma Knife® in secreting and nonsecreting pituitary adenomas. Long-term data confirm the antisecretory efficacy of the procedure (about 50% remission in hypersecreting tumors) but also a previously unknown low risk of recurrence (2–10% of cases). The time to remission is estimated to range from 12 to 60 months. The antitumoral efficacy of this treatment against nonsecreting tumors is observed in about 90% of cases. Hypopituitarism is the main adverse effect, observed in 20–40% of cases. Comparisons with conventional fractionated radiotherapy reveal a lower rate of remission with Gamma Knife® radiosurgery, counterbalanced by a more rapid efficacy and a lower rate of hypopituitarism. Short-term follow-up results on stereotactic fractionated radiotherapy suggest a risk of hypopituitarism similar to the one observed with radiosurgery. Therefore, stereotactic radiosurgery is probably still useful to treat some cases of pituitary adenoma, despite the fact that antisecretory drugs, particularly for acromegaly and prolactinomas, are becoming more effective and are well tolerated, thus increasing the probability of success with nonsurgical therapy.

Key Points

  • Gamma knife radiosurgery is a neurosurgical technique that uses radiation aimed at controlling hormonal secretion and tumor volume in pituitary adenomas

  • Antisecretory efficacy is observed in 40–50% of cases of secreting adenomas; the main predictive factors are low target volume, low initial hormone levels and possibly concomitant medication at the time of radiosurgery

  • Antitumoral efficacy is observed in more than 90–95% of cases of nonsecreting adenomas

  • The long-term recurrence risk is substantial, particularly in Cushing disease, where 10–20% of cases recur, usually several years after the radiosurgical procedure

  • The main adverse effect is hypopituitarism, observed in 20–40% of cases, whose risk increases with time after radiosurgery, decreasing after about 120 months

  • Results from long-term follow-up studies do not modify our current algorithms for treating pituitary adenomas, but they draw attention to the necessity for a regular follow-up after radiosurgery

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Centre de Réference des Maladies Rares d'Origine Hypophysaire, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Rue St Pierre, Université de la Mediterranée, Aix-Marseille 2, Marseille Cedex 05, 13385, France

    Frederic Castinetti & Thierry Brue

  2. Departement de Neurochirurgie et Neurochirurgie Fonctionnelle, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Rue St Pierre, Université de la Mediterranée, Aix-Marseille 2, Marseille Cedex 05, 13385, France

    Jean Régis & Henry Dufour

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Correspondence to Frederic Castinetti.

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J. Régis has received research support from the following companies: Accuray, Brainlab, Elekta, TomoTherapy. The other authors, the Journal Editor V. Heath and the CME questions author C. P. Vega declare no competing interests.

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Castinetti, F., Régis, J., Dufour, H. et al. Role of stereotactic radiosurgery in the management of pituitary adenomas. Nat Rev Endocrinol 6, 214–223 (2010). https://doi.org/10.1038/nrendo.2010.4

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