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• W2034713486 abstract "To evaluate the efficacy and safety of stereotactic proton radiosurgery (P-SRS) delivered using CT/MRI-based treatment planning for functioning (F) and non-functioning (NF) pituitary adenomas. Between August 1993 and July 2003, 61 patients were treated with P-SRS for residual or recurrent pituitary adenomas at Massachusetts General Hospital. Fifty patients presented with biochemical evidence of residual or recurrent Cushing disease (n = 27), acromegaly (n = 18), prolactinoma (n = 3), or TSH-secreting tumor (n = 2). Eleven patients had NF adenomas with evidence of local progression. Median age was 41 years (range 14–79). Sixty patients had prior surgery with a median of 2 transspenoidal resections (range 1–4) and 1 patient had none. P-SRS was delivered at the Harvard University Cyclotron (1993–2001) or Northeast Proton Center (2002–2003) using 2–5 convergent beams. Treatment planning was based on fused CT/MRI images in all cases. Median dose was 20 CGE (range 15–24) for F adenomas and 17 CGE (range 15–20) for NF adenomas. Median treatment volume was 1.3 cc (range 0.45–6.3) for F adenomas and 1.6 cc (range 1.1–3.7) for NF adenomas. The dose to the optic chiasm was limited < 8 CGE in all cases. Endocrine follow-up included serial testing of urine free cortisol for Cushing disease, IGF-1 for acromegaly, prolactin for prolactinoma, and free T4 for TSH-secreting tumor. The primary endpoint for F tumors was normalization of endocrine testing without medical suppression (complete response). The secondary endpoint was normalization of endocrine testing on continued medical suppression (partial response). The primary endpoint for NF tumors was local control based on both MRI and clinical follow-up. Patient and treatment characteristics were evaluated for statistical association with outcomes. Complete endocrine and radiographic follow-up was available for 57 patients (94%) at a median 34 months (range 8–107) after treatment. Complete response was obtained in 12 patients with Cushing disease (48%), 10 with acromegaly (63%), and 2 with prolactinoma (66.6%). Median time to complete response was 20.5 months (range 6–60). Partial response was observed in 7 patients with Cushing disease (28%), 3 with acromegaly (19%), 1 with prolactinoma (33.3%), and 2 with TSH-secreting tumor (100%). Complete or partial response rates were 76%, 81%, 100%, and 100% for Cushing disease, acromegaly, prolactinoma, and TSH-secreting tumor, respectively. All patients with NF adenomas maintained local control and 3 patients (27%) demonstrated greater than 50% tumor shrinkage. Nine patients with NF adenomas presented with visual disturbances that resolved in 3 patients (33%), improved in 4 (44%), and remained stable in 2 (22%). Poor response was associated with Nelson Syndrome (50% vs. 85%, p = NS) and cavernous sinus involvement (67% vs. 90%, P = 0.04). Among 49 patients with pituitary function, 9 (18%) had partial pituitary failure and 2 (4%) had complete pituitary failure after treatment. Median time to pituitary failure was 17 months (range 2–41). No visual complications were reported. Radiation effect in the temporal lobe was reported in MRI follow-up for 2 patients and was associated with temporary seizure activity for 6 months in 1 patient. Both patients had been treated for adjacent cavernous sinus involvement and neither sustained long-term injury. P-SRS is efficacious in the management of residual or recurrent pituitary adenomas. This study supports a body of literature suggesting that radiosurgery results in expeditious biochemical response with minimal morbidity. P-SRS is advantageous for larger tumors and those in close proximity to the optic pathways where other radiosurgical techniques are limited." @default.
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• W2034713486 date "2004-09-01" @default.
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• W2034713486 title "Proton radiosurgery in the management of functioning and non-functioning pituitary adenomas: A 10-year experience at the massachusetts general hospital" @default.
• W2034713486 doi "https://doi.org/10.1016/j.ijrobp.2004.07.121" @default.
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