Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas

James L. Leenstra, Shota Tanaka, Robert W. Kline, Paul D. Brown, Michael J. Link, Todd B. Nippoldt, William Francis Young, Bruce E. Pollock

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: To analyze the factors associated with anterior pituitary deficits after pituitary adenoma stereotactic radiosurgery (SRS). METHODS: The tumor, pituitary stalk, and pituitary gland were segmented on the dose plans of 82 patients (secreting tumors, n = 53; nonsecreting tumors, n = 29) for dose-volume analysis. No patient had undergone prior radiation therapy and all patients had at least 12 months of endocrinological follow-up (median, 63 months; mean, 69 months; range, 13-134). RESULTS: Thirty-four patients (41%) developed new anterior pituitary deficits at a median of 32 months (range, 2-118) after SRS. The risk of developing new anterior pituitary deficits was 16% and 45% at 2 and 5 years, respectively. Multivariate analysis of the entire group showed that poor visualization of the pituitary gland (hazard ratio [HR] = 2.63, 95% confidence interval [CI] = 1.10-6.25, P = .03) was associated with a higher rate of new anterior pituitary deficits. Dosimetric analysis of 60 patients whose pituitary gland could be clearly identified showed that increasing mean pituitary gland radiation dose correlated with new anterior pituitary deficits (HR = 1.11, 95% CI = 1.02-1.20, P = .02). New anterior pituitary deficits stratified by mean pituitary gland radiation dose: ≤7.5 Gy, 0% (0/7); 7.6 to 13.2 Gy, 29% (7/24); 13.3 to 19.1 Gy, 39% (9/23); >19.1 Gy, 83% (5/6). CONCLUSION: New endocrine deficits after pituitary adenoma radiosurgery were correlated with increasing radiation dose to the pituitary gland. Methods that limit the radiation dose to the pituitary gland during SRS may increase the probability of preserving pituitary function.

Original languageEnglish (US)
Pages (from-to)27-32
Number of pages6
JournalNeurosurgery
Volume67
Issue number1
DOIs
StatePublished - Jul 2010

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Radiosurgery
Pituitary Neoplasms
Pituitary Gland
Radiation
Confidence Intervals
Neoplasms
Statistical Factor Analysis
Radiotherapy
Multivariate Analysis

Keywords

  • Acromegaly
  • Cushing s disease
  • Pituitary adenoma
  • Prolactin
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Leenstra, J. L., Tanaka, S., Kline, R. W., Brown, P. D., Link, M. J., Nippoldt, T. B., ... Pollock, B. E. (2010). Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas. Neurosurgery, 67(1), 27-32. https://doi.org/10.1227/01.NEU.0000370978.31405.A9

Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas. / Leenstra, James L.; Tanaka, Shota; Kline, Robert W.; Brown, Paul D.; Link, Michael J.; Nippoldt, Todd B.; Young, William Francis; Pollock, Bruce E.

In: Neurosurgery, Vol. 67, No. 1, 07.2010, p. 27-32.

Research output: Contribution to journalArticle

Leenstra, JL, Tanaka, S, Kline, RW, Brown, PD, Link, MJ, Nippoldt, TB, Young, WF & Pollock, BE 2010, 'Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas', Neurosurgery, vol. 67, no. 1, pp. 27-32. https://doi.org/10.1227/01.NEU.0000370978.31405.A9
Leenstra, James L. ; Tanaka, Shota ; Kline, Robert W. ; Brown, Paul D. ; Link, Michael J. ; Nippoldt, Todd B. ; Young, William Francis ; Pollock, Bruce E. / Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas. In: Neurosurgery. 2010 ; Vol. 67, No. 1. pp. 27-32.
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abstract = "OBJECTIVE: To analyze the factors associated with anterior pituitary deficits after pituitary adenoma stereotactic radiosurgery (SRS). METHODS: The tumor, pituitary stalk, and pituitary gland were segmented on the dose plans of 82 patients (secreting tumors, n = 53; nonsecreting tumors, n = 29) for dose-volume analysis. No patient had undergone prior radiation therapy and all patients had at least 12 months of endocrinological follow-up (median, 63 months; mean, 69 months; range, 13-134). RESULTS: Thirty-four patients (41{\%}) developed new anterior pituitary deficits at a median of 32 months (range, 2-118) after SRS. The risk of developing new anterior pituitary deficits was 16{\%} and 45{\%} at 2 and 5 years, respectively. Multivariate analysis of the entire group showed that poor visualization of the pituitary gland (hazard ratio [HR] = 2.63, 95{\%} confidence interval [CI] = 1.10-6.25, P = .03) was associated with a higher rate of new anterior pituitary deficits. Dosimetric analysis of 60 patients whose pituitary gland could be clearly identified showed that increasing mean pituitary gland radiation dose correlated with new anterior pituitary deficits (HR = 1.11, 95{\%} CI = 1.02-1.20, P = .02). New anterior pituitary deficits stratified by mean pituitary gland radiation dose: ≤7.5 Gy, 0{\%} (0/7); 7.6 to 13.2 Gy, 29{\%} (7/24); 13.3 to 19.1 Gy, 39{\%} (9/23); >19.1 Gy, 83{\%} (5/6). CONCLUSION: New endocrine deficits after pituitary adenoma radiosurgery were correlated with increasing radiation dose to the pituitary gland. Methods that limit the radiation dose to the pituitary gland during SRS may increase the probability of preserving pituitary function.",
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AU - Leenstra, James L.

AU - Tanaka, Shota

AU - Kline, Robert W.

AU - Brown, Paul D.

AU - Link, Michael J.

AU - Nippoldt, Todd B.

AU - Young, William Francis

AU - Pollock, Bruce E.

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N2 - OBJECTIVE: To analyze the factors associated with anterior pituitary deficits after pituitary adenoma stereotactic radiosurgery (SRS). METHODS: The tumor, pituitary stalk, and pituitary gland were segmented on the dose plans of 82 patients (secreting tumors, n = 53; nonsecreting tumors, n = 29) for dose-volume analysis. No patient had undergone prior radiation therapy and all patients had at least 12 months of endocrinological follow-up (median, 63 months; mean, 69 months; range, 13-134). RESULTS: Thirty-four patients (41%) developed new anterior pituitary deficits at a median of 32 months (range, 2-118) after SRS. The risk of developing new anterior pituitary deficits was 16% and 45% at 2 and 5 years, respectively. Multivariate analysis of the entire group showed that poor visualization of the pituitary gland (hazard ratio [HR] = 2.63, 95% confidence interval [CI] = 1.10-6.25, P = .03) was associated with a higher rate of new anterior pituitary deficits. Dosimetric analysis of 60 patients whose pituitary gland could be clearly identified showed that increasing mean pituitary gland radiation dose correlated with new anterior pituitary deficits (HR = 1.11, 95% CI = 1.02-1.20, P = .02). New anterior pituitary deficits stratified by mean pituitary gland radiation dose: ≤7.5 Gy, 0% (0/7); 7.6 to 13.2 Gy, 29% (7/24); 13.3 to 19.1 Gy, 39% (9/23); >19.1 Gy, 83% (5/6). CONCLUSION: New endocrine deficits after pituitary adenoma radiosurgery were correlated with increasing radiation dose to the pituitary gland. Methods that limit the radiation dose to the pituitary gland during SRS may increase the probability of preserving pituitary function.

AB - OBJECTIVE: To analyze the factors associated with anterior pituitary deficits after pituitary adenoma stereotactic radiosurgery (SRS). METHODS: The tumor, pituitary stalk, and pituitary gland were segmented on the dose plans of 82 patients (secreting tumors, n = 53; nonsecreting tumors, n = 29) for dose-volume analysis. No patient had undergone prior radiation therapy and all patients had at least 12 months of endocrinological follow-up (median, 63 months; mean, 69 months; range, 13-134). RESULTS: Thirty-four patients (41%) developed new anterior pituitary deficits at a median of 32 months (range, 2-118) after SRS. The risk of developing new anterior pituitary deficits was 16% and 45% at 2 and 5 years, respectively. Multivariate analysis of the entire group showed that poor visualization of the pituitary gland (hazard ratio [HR] = 2.63, 95% confidence interval [CI] = 1.10-6.25, P = .03) was associated with a higher rate of new anterior pituitary deficits. Dosimetric analysis of 60 patients whose pituitary gland could be clearly identified showed that increasing mean pituitary gland radiation dose correlated with new anterior pituitary deficits (HR = 1.11, 95% CI = 1.02-1.20, P = .02). New anterior pituitary deficits stratified by mean pituitary gland radiation dose: ≤7.5 Gy, 0% (0/7); 7.6 to 13.2 Gy, 29% (7/24); 13.3 to 19.1 Gy, 39% (9/23); >19.1 Gy, 83% (5/6). CONCLUSION: New endocrine deficits after pituitary adenoma radiosurgery were correlated with increasing radiation dose to the pituitary gland. Methods that limit the radiation dose to the pituitary gland during SRS may increase the probability of preserving pituitary function.

KW - Acromegaly

KW - Cushing s disease

KW - Pituitary adenoma

KW - Prolactin

KW - Stereotactic radiosurgery

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