Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F18%3A00007317" target="_blank" >RIV/00023884:_____/18:00007317 - isvavai.cz</a>

Výsledek na webu

<a href="http://dx.doi.org/10.3171/2017.5.JNS163069" target="_blank" >http://dx.doi.org/10.3171/2017.5.JNS163069</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.3171/2017.5.JNS163069" target="_blank" >10.3171/2017.5.JNS163069</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study

Popis výsledku v původním jazyce

Background. Gamma Knife radiosurgery (GKRS) is frequently used to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of imaging-defined progression of tumor. Given the high incidence of adenoma progression after subtotal resection over time, the present study is intended to evaluate the effect of timing of radiosurgery on outcome. Methods. This is a multi-center retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS from 1987 to 2015 at nine institutions of the International Gamma Knife Research Foundation. Patients were matched by adenoma and radiosurgical parameters and stratified based on the interval between last resection and radiosurgery. Operative results, imaging and clinical outcomes were compared across groups following early (6 months after resection) or late (>6 months after resection) radiosurgery. Results. After matching, two-hundred and twenty-two patients met our study criteria (from an initial collection of 496 patients) and were grouped based on early (n=111) or late (n=111) GKRS following transsphenoidal surgery. There was greater risk of tumor progression after GKRS (p=0.013) and residual tumor (p=0.038) in the late radiosurgical group over a median imaging follow-up period of 68.5 months. No significant difference in occurrence of post-GKRS endocrinopathy was observed (p=0.68). Thirty percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 27% in the late cohort (p=0.84). Fourteen percent of the early group and 25% of the late group experienced resolution of endocrine dysfunction since original presentation (p=0.32). Conclusions. In this study, early GKRS appears to decrease the risk of radiographic progression of sub-totally resected nonfunctioning pituitary macroadenomas compared to expectant management followed by late radiosurgery. Delaying radiosurgery may place patients at increased risk for long-term adenoma progression. The timing of radiosurgery does not appear to significantly affect the rate of delayed endocrinopathy.

Název v anglickém jazyce

Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study

Popis výsledku anglicky

Background. Gamma Knife radiosurgery (GKRS) is frequently used to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of imaging-defined progression of tumor. Given the high incidence of adenoma progression after subtotal resection over time, the present study is intended to evaluate the effect of timing of radiosurgery on outcome. Methods. This is a multi-center retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS from 1987 to 2015 at nine institutions of the International Gamma Knife Research Foundation. Patients were matched by adenoma and radiosurgical parameters and stratified based on the interval between last resection and radiosurgery. Operative results, imaging and clinical outcomes were compared across groups following early (6 months after resection) or late (>6 months after resection) radiosurgery. Results. After matching, two-hundred and twenty-two patients met our study criteria (from an initial collection of 496 patients) and were grouped based on early (n=111) or late (n=111) GKRS following transsphenoidal surgery. There was greater risk of tumor progression after GKRS (p=0.013) and residual tumor (p=0.038) in the late radiosurgical group over a median imaging follow-up period of 68.5 months. No significant difference in occurrence of post-GKRS endocrinopathy was observed (p=0.68). Thirty percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 27% in the late cohort (p=0.84). Fourteen percent of the early group and 25% of the late group experienced resolution of endocrine dysfunction since original presentation (p=0.32). Conclusions. In this study, early GKRS appears to decrease the risk of radiographic progression of sub-totally resected nonfunctioning pituitary macroadenomas compared to expectant management followed by late radiosurgery. Delaying radiosurgery may place patients at increased risk for long-term adenoma progression. The timing of radiosurgery does not appear to significantly affect the rate of delayed endocrinopathy.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30103 - Neurosciences (including psychophysiology)

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2018

Kód důvěrnosti údajů

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

Název periodika

Journal of Neurosurgery

ISSN

0022-3085

e-ISSN

—

Svazek periodika

129

Číslo periodika v rámci svazku

3

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

10

Strana od-do

648-657

Kód UT WoS článku

000443287000010

EID výsledku v databázi Scopus

2-s2.0-85052593982