Document Detail


Gamma knife radiosurgery: a safe and effective salvage treatment for pituitary tumours not controlled despite conventional radiotherapy.
MedLine Citation:
PMID:  19773368     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We report the use of 'gamma knife' (GK) radiosurgery in 25 patients with pituitary adenomas not cured despite conventional therapy, including external beam radiotherapy. PATIENTS AND METHODS: All patients had previously received conventional radiotherapy for a mean of 11.8 years prior to receiving GK; 23 out of 25 had also undergone pituitary surgery on at least one occasion. Seventeen had hyperfunctioning adenomas that still required medical therapy without an adequate biochemical control--ten somatotroph adenomas, six corticotroph adenomas and one prolactinoma, while eight patients had non-functioning pituitary adenomas (NFPAs). RESULTS: Following GK, mean GH fell by 49% at 1 year in patients with somatotroph tumours. Serum IGF1 fell by 32% at 1 year and by 38% at 2 years. To date, 80% of the patients with acromegaly have achieved normalisation of IGF1, and 30% have also achieved a mean GH level of <1.8 ng/ml correlating with normalised mortality. A total of 75% NFPAs showed disease stabilisation or shrinkage post GK. The patient with a prolactinoma showed a dramatic response: 75% reduction in prolactin at 2 years, with a marked shrinkage on magnetic resonance imaging. The results in corticotroph adenomas were variable. Prior to GK, 72% of the patients were panhypopituitary, and 42% of the remainder have developed new anterior pituitary hormone deficiencies to date. No other adverse events have been detected at a mean follow-up of 36.4 months. CONCLUSIONS: These data indicate that GK is a safe and effective adjunctive treatment for patients with NFPAs and acromegaly not satisfactorily controlled with surgery and radiotherapy.
Authors:
F M Swords; J P Monson; G M Besser; S L Chew; W M Drake; A B Grossman; P N Plowman
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Publication Detail:
Type:  Journal Article     Date:  2009-09-22
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  161     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  819-28     Citation Subset:  IM    
Affiliation:
Department of Oncology, Barts and the London NHS Trust, West Smithfield, London EC1A 7BE, UK.
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MeSH Terms
Descriptor/Qualifier:
ACTH-Secreting Pituitary Adenoma / surgery
Adenoma / surgery
Adult
Aged
Female
Growth Hormone-Secreting Pituitary Adenoma / surgery
Human Growth Hormone / blood
Humans
Insulin-Like Growth Factor I / metabolism
Male
Middle Aged
Pituitary Neoplasms / radiotherapy,  surgery*
Prolactinoma / surgery
Radiosurgery*
Treatment Outcome
Chemical
Reg. No./Substance:
12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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