Adjuvant versus on-progression Gamma Knife radiosurgery for residual nonfunctioning pituitary adenomas: a matched-cohort analysis

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F23%3A00009710" target="_blank" >RIV/00023884:_____/23:00009710 - isvavai.cz</a>

Result on the web

<a href="https://thejns.org/view/journals/j-neurosurg/138/6/article-p1662.xml" target="_blank" >https://thejns.org/view/journals/j-neurosurg/138/6/article-p1662.xml</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.3171/2022.10.JNS221873" target="_blank" >10.3171/2022.10.JNS221873</a>

Result language

angličtina

Original language name

Adjuvant versus on-progression Gamma Knife radiosurgery for residual nonfunctioning pituitary adenomas: a matched-cohort analysis

Original language description

OBJECTIVE Radiological progression occurs in 50%-60% of residual nonfunctioning pituitary adenomas (NFPAs). Stereotactic radiosurgery (SRS) is a safe and effective management option for residual NFPAs, but there is no consen-sus on its optimal timing. This study aims to define the optimal timing of SRS for residual NFPAs. METHODS This retrospective, multicenter study involved 375 patients with residual NFPAs managed with SRS. The patients were divided into adjuvant (ADJ; treated for stable residual NFPA within 6 months of resection) and progression (PRG) cohorts (treated for residual NFPA progression). Factors associated with tumor progression and clinical deteriora-tion were analyzed.RESULTS Following propensity-score matching, each cohort consisted of 130 patients. At last follow-up, tumor con-trol was achieved in 93.1% of patients in the ADJ cohort and in 96.2% of patients in the PRG cohort (HR 1.6, 95% CI 0.55-4.9, p = 0.37). Hypopituitarism was associated with a maximum point dose of > 8 Gy to the pituitary stalk (HR 4.5, 95% CI 1.6-12.6, p = 0.004). No statistically significant difference was noted in crude new-onset hypopituitarism rates (risk difference [RD] = -0.8%, p > 0.99) or visual deficits (RD = -2.3%, p = 0.21) between the two cohorts at the last follow-up. The median time from resection to new hypopituitarism was longer in the PRG cohort (58.9 vs 29.7 months, p = 0.01).CONCLUSIONS SRS at residual NFPA progression does not appear to alter the probability of tumor control or hormon-al/visual deficits compared with adjuvant SRS. Deferral of radiosurgical management to the time of radiological progres- sion could significantly prolong the time to radiosurgically induced pituitary dysfunction. A lower maximum point dose (< 8 Gy) to the pituitary stalk portended a more favorable chance of preserving pituitary function after SRS. https://thejns.org/doi/abs/10.3171/2022.10.JNS221873

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30210 - Clinical neurology

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2023

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Journal of Neurosurgery

ISSN

0022-3085

e-ISSN

—

Volume of the periodical

138

Issue of the periodical within the volume

6

Country of publishing house

US - UNITED STATES

Number of pages

7

Pages from-to

1662-1668

UT code for WoS article

001018876000020

EID of the result in the Scopus database

2-s2.0-85163728853