Dose dependence incidence of new pituitary deficits after Gamma Knife Surgery (GKS) of pituitary adenomasAntonella Del Vecchio1, Gianluisa Sicignano2, Giovanni Mauro Cattaneo2, Patrizia Signorotto2, Piero Picozzi, MD3, Marco Losa4, Angelo Bolognesi5, Pietro Mortini4, Riccardo Calandrino21Milan, Italy 2Medical Physics Dept., San Raffaele Scientific Institute 3Department of Neurosurgery, IRCCS San Raffaele 4Neurosurgery Dept., San Raffaele Scientific Institute 5Radiation Oncology Dept., San Raffaele Scientific Institute Keywords: gamma knife, hormone dysfunction, pituitary adenoma, radiosurgery, outcomeInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Hormone status after radiosurgery is important to document. What is the purpose of your study?The aim is to define clinical and healthy-tissue dosimetric factors
predicting the development of hypopituitarism after Gamma Knife
treatments, in order to optimize the radiation delivery procedure. Describe your patient group.Between 2001 and 2008, 367 patients with a diagnosis of pituitary
adenoma were treated in the Gamma Knife Centre of San Raffaele Hospital -
Milan. Between 2001 and June 2007, they have been treated with Leksell
gamma Knife Model C, after September 2007 with Gamma Knife Perfexion. In
this study we decided to consider only 130 patients who had complete
clinical information and a follow up of at least 6 months (6-103) after
GK radiosurgery. Diagnosis was of non functioning pituitary adenoma
(NFPA) in 68 patients and secreting pituitary adenoma (SPA) in 62. Describe what you did. Hypopituitarism was defined as a new pituitary deficit in (at least) one of the three hormonal axes (hypogonadism, hypotiroidism and hypoadrenalism) that we considered in our analysis. Before GK radiosurgery, 62 patients had no prior pituitary deficit for all hormonal axes and 94 patients only for hypotiroidism and hypoadrenalism axes. Median marginal dose was 15 Gy (15-25 Gy) for NFPA and 25 Gy (12-25 Gy) for SPA at 50% reference isodose, in the same time treatment plans were optimized in order to use dose constrains utilized in our clinical practice. For all patients tumor, pituitary stalk and pituitary gland were outlined using the Elekta GammaPlan. The predictive value of the considered variables was tested by univariate and multivariate logistic analyses. Describe your main findings.After GK radiosurgery, more than 12% of the patients showed a new pituitary deficit in at least one of three hormonal axes taken into account. The Results of the univariate analyses showed that a few clinical and many dosimetric parameters were associated with a higher rate of new pituitary deficits. Preliminary Results of multivariate analysis, confirmed the significant correlation between the mean dose to the stalk and to the (healthy) pituitary and the rate of new pituitary toxicities. Describe the main limitation of this study.This was a retrospective study. Describe your main conclusion.The analysis showed a dose-dependence incidence of new hormonal deficits after GK. Describe the importance of your findings and how they can be used by others.During planning definition, the risk of hypopituitarism could be reduced using the outlined dose-volume predictors. Hormone status after radiosurgery is important to document.
The aim is to define clinical and healthy-tissue dosimetric factors
predicting the development of hypopituitarism after Gamma Knife
treatments, in order to optimize the radiation delivery procedure. Between 2001 and 2008, 367 patients with a diagnosis of pituitary
adenoma were treated in the Gamma Knife Centre of San Raffaele Hospital -
Milan. Between 2001 and June 2007, they have been treated with Leksell
gamma Knife Model C, after September 2007 with Gamma Knife Perfexion. In
this study we decided to consider only 130 patients who had complete
clinical information and a follow up of at least 6 months (6-103) after
GK radiosurgery. Diagnosis was of non functioning pituitary adenoma
(NFPA) in 68 patients and secreting pituitary adenoma (SPA) in 62. Hypopituitarism was defined as a new pituitary deficit in (at least) one of the three hormonal axes (hypogonadism, hypotiroidism and hypoadrenalism) that we considered in our analysis. Before GK radiosurgery, 62 patients had no prior pituitary deficit for all hormonal axes and 94 patients only for hypotiroidism and hypoadrenalism axes. Median marginal dose was 15 Gy (15-25 Gy) for NFPA and 25 Gy (12-25 Gy) for SPA at 50% reference isodose, in the same time treatment plans were optimized in order to use dose constrains utilized in our clinical practice. For all patients tumor, pituitary stalk and pituitary gland were outlined using the Elekta GammaPlan. The predictive value of the considered variables was tested by univariate and multivariate logistic analyses. After GK radiosurgery, more than 12% of the patients showed a new pituitary deficit in at least one of three hormonal axes taken into account. The Results of the univariate analyses showed that a few clinical and many dosimetric parameters were associated with a higher rate of new pituitary deficits. Preliminary Results of multivariate analysis, confirmed the significant correlation between the mean dose to the stalk and to the (healthy) pituitary and the rate of new pituitary toxicities. This was a retrospective study. The analysis showed a dose-dependence incidence of new hormonal deficits after GK.
During planning definition, the risk of hypopituitarism could be reduced using the outlined dose-volume predictors. Project Roles:
A. Del Vecchio (), G. Sicignano (), G. Cattaneo (), P. Signorotto (), P. Picozzi (), M. Losa (), A. Bolognesi (), P. Mortini (), R. Calandrino ()
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