Frontiers in oncology · 2025
Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol.
СтатьяНазвание и аннотация: Перевод в очереди
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Bhatnagar Akrita, Marin Monica Pernia, Lischalk Jonathan W, Koh Min Ji, Agazzi Siviero, Suy Simeng, Harris Brent T, Sharma Susmeeta T, Aulisi Edward, Anaizi Amjad, Khattab Mohamed H, Jean Walter C, Collins Sean P, Collins Brian T
Аннотация
OBJECTIVE: Nonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established in the literature for single-fraction frame-based radiosurgery, but mature outcomes are lacking for fractionated frameless radiosurgery. We report our institution's 5-year efficacy and toxicity results for unfavorable nonfunctioning pituitary macroadenoma patients treated with 5-fraction robotic radiosurgery.
METHODS: Between 2010 and 2020, patients who completed 5-fraction robotic radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem, or pituitary gland). Local control was calculated using the Kaplan-Meier method.
RESULTS: Twenty predominantly female patients (60%), ages 21-77 (median: 53 years), were included in this study. All underwent primary resection at the time of diagnosis. The indication for radiosurgery was tumor progression (n = 14, 70%) or residual tumor after subtotal resection (n = 6, 30%). Eighty-five percent of patients treated with radiosurgery (n = 17) had cavernous sinus involvement. Median GTV was 3.4 cm3 (range: 0.3-20.8 cm3), and 40% of the tumors had suprasellar extension. A mean dose of 28.8 Gy (range: 25-30 Gy) was delivered to a median isodose line of 80% (range: 75%-89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0-25.0 Gy). Acute toxicity was minimal with eight patients (40%) developing short-lived headaches and one patient (5%) developing a brief ipsilateral sixth nerve palsy. There was no late radiation-induced neurologic or optic dysfunction identified in this cohort. At a median follow-up of 5 years, local control was 94%. There was one in-field failure pathologically confirmed following surgery for pituitary hemorrhage and two radiographically confirmed out-of-field failures in patients with larger tumors (>20 cc).
CONCLUSIONS: The treatment of unfavorable nonfunctioning pituitary macroadenoma with 5-fraction robotic radiosurgery provides excellent local control to date, with acceptable toxicity. However, tumors with GTVs greater than 20 cc may still require conventionally fractionated treatment with a margin to optimize local control.
METHODS: Between 2010 and 2020, patients who completed 5-fraction robotic radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem, or pituitary gland). Local control was calculated using the Kaplan-Meier method.
RESULTS: Twenty predominantly female patients (60%), ages 21-77 (median: 53 years), were included in this study. All underwent primary resection at the time of diagnosis. The indication for radiosurgery was tumor progression (n = 14, 70%) or residual tumor after subtotal resection (n = 6, 30%). Eighty-five percent of patients treated with radiosurgery (n = 17) had cavernous sinus involvement. Median GTV was 3.4 cm3 (range: 0.3-20.8 cm3), and 40% of the tumors had suprasellar extension. A mean dose of 28.8 Gy (range: 25-30 Gy) was delivered to a median isodose line of 80% (range: 75%-89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0-25.0 Gy). Acute toxicity was minimal with eight patients (40%) developing short-lived headaches and one patient (5%) developing a brief ipsilateral sixth nerve palsy. There was no late radiation-induced neurologic or optic dysfunction identified in this cohort. At a median follow-up of 5 years, local control was 94%. There was one in-field failure pathologically confirmed following surgery for pituitary hemorrhage and two radiographically confirmed out-of-field failures in patients with larger tumors (>20 cc).
CONCLUSIONS: The treatment of unfavorable nonfunctioning pituitary macroadenoma with 5-fraction robotic radiosurgery provides excellent local control to date, with acceptable toxicity. However, tumors with GTVs greater than 20 cc may still require conventionally fractionated treatment with a margin to optimize local control.