Abstract
Fractionated radiotherapy for pituitary tumors and tumors arising in the parasellar region has been used for a century. The multidisciplinary nature of optimal management of tumors of the anterior skull base has been clearly established; the expertise of endocrinologists, neurosurgeons, radiation oncologists, neuroradiologists, neuroophthalmologists, and laboratory medicine specialists are all commonly required to optimally manage tumors that arise in the pituitary or pituitary region. The skull base structures surrounding the pituitary gland are anatomically complex [1]. The proximity of a number of important vascular structures and cranial nerves makes a surgical approach to tumors arising in the pituitary region complex; accordingly, complete resections with acceptable operative morbidity can be difficult to achieve. Iatrogenic damage may occur during the treatment of an anterior skull base tumor that may result in endocrinologic, visual, or other neurologic deficits. Radiation can induce second tumors and cause endocrine insufficiencies. It is easy to appreciate the potential of iatrogenic damage to decrease the quality of life for patients that may live for decades after an intervention.
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References
Rhoton AL Jr. The anterior and middle cranial base. Neurosurgery 2002;51:S273–S302.
Laws ER Jr, Thapar K. Brain tumors. CA Cancer J Clin 1993;43:263–271.
Costello RT. Subclinical adenoma of the pituitary gland. Am J Pathol 1936;12:205–216.
Kernohan JW, Sayre GP. Tumors of the pituitary gland and infundibulum. In: Atlas of Tumor Pathology. Washington, DC: Armed Forces Institute of Pathology, Section X, Fascicle 36, 1956.
DeMonte F, Al-Mefty O. Meningiomas. In: Kaye AH, Laws ER, eds. Brain Tumors. New York: Churchill Livingstone, 1995:675–704.
Moss J, DeCastro R, Patronas NJ, et al. Meningiomas in lymphangioleiomyomatosis. JAMA 2001;286:1879–1881.
Louis DN, Scheithauer BW, Budka H, et al. Meningiomas. In: Kleihues P, Cavenee WK, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Nervous System. Lyon: IARC Press, 2000:176–184.
Perry A, Stafford SL, Scheithauer BW, et al. Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol 1997;21:1455–1465.
Perry A, Scheithauer BW, Stafford SL, et al. “Malignancy“ in meningiomas: a clinicopathologic study of 116 patients. Cancer 1999;85:2046–2056.
Kahn EA, Gosch HH, Seeger JF, et al. Forty-five years experience with the craniopharyngiomas. Surg Neurol 1973;1:5–12.
Yasargil MG, Curcic M, Kis M, et al. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 1990;73:3–11.
Adamson TE, Wiestler OD, Kleihues P, et al. Correlation of clinical and pathological features in surgically treated craniopharyngiomas. J Neurosurg 1990;73:12–17.
Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 1969;16:185–217.
Leavens ME, McCutcheon IF, Samaan NA. Management of pituitary adenomas. Oncology (Williston Park). 1992;6(6):69–79;discussion 79–80.
Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957;20:22–39.
Tsang RW, Brierley JD, Panzarella T, et al. Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1994;30:557–565.
Perry A, Gutmann DH, Reifenberger G. Molecular pathogenesis of meningiomas. J Neurooncol 2004;70:183–202.
Perry A. Unmasking the secrets of meningioma: a slow but rewarding journey. Surg Neurol 2004;61:171–173.
Molitch ME. Medical management of prolactin-secreting pituitary adenomas. Pituitary 2002;5:55–65.
Racine MS, Barkan AL. Medical management of growth hormonesecreting pituitary adenomas. Pituitary 2002;5:67–76.
Beck-Peccoz P, Persani L. Medical management of thyrotropinsecreting pituitary adenomas. Pituitary 2002;5:83–88.
Tishler RB, Loeffler JS, Lunsford LD, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993;27:215–221.
Leber KA, Bergloff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998;88:43–50.
Stafford SL, Pollock BE, Leavitt JA, et al. A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2003;55:1177–1181.
van den Bergh AC, Schoorl MA, Dullaart RP, et al. Lack of radiation optic neuropathy in 72 patients treated for pituitary adenoma. J Neuroophthalmol 2004;24:200–205.
al-Mefty O, Kersh JE, Routh A, et al. The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 1990;73:502–512.
Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003;56:83–88.
Marks JE, Baglan RJ, Prassad SC, et al. Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 1981;7:243–252.
Goldsmith BJ, Larson DA. Conventional radiation therapy for skull base meningiomas. Neurosurg Clin N Am 2000;11:605–615.
Graham JD, Nahum AE, Brada M. A comparison of techniques for stereotactic radiotherapy by linear accelerator based on 3-dimensional dose distributions. Radiother Oncol 1991;22:29–35.
Perks JR, Jalali R, Cosgrove VP, et al. Optimization of stereotactically-guided conformal treatment planning of sellar and parasellar tumors, based on normal brain dose volume histograms. Int J Radiat Oncol Biol Phys 1999;45:507–513.
Kondziolka D, Lunsford LD, Loeffler JS, et al. Radiosurgery and radiotherapy: observations and clarifications. J Neurosurg 2004;101:585–589.
Brada M, Rajan B, Traish D, et al. The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 1993;38:571–578.
Tsang RW, Brierley JD, Panzarella T, et al. Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol 1996;41:45–53.
McCord MW, Buatti JM, Fennell EM, et al. Radiotherapy for pituitary adenoma: long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 1997;39:437–444.
Zierhut D, Flentje M, Adolph J, et al. External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 1995;33:307–314.
Milker-Zabel S, Debus J, Thilmann C, et al. Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys 2001;50:1279–1286.
Grabenbauer GG, Fietkau R, Buchfelder M, et al. Hormonally inactive hypophyseal adenomas: the results and late sequelae after surgery and radiotherapy. Strahlenther Onkol 1996;172:193–197.
Woollons AC, Hunn MK, Rajapakse YR, et al. Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf) 2000;53:713–717.
Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, et al. Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery 1998;43:432–438.
Greenman Y, Ouaknine G, Veshchev I, et al. Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 2003;58:763–769.
Grigsby PW, Simpson JR, Fineberg B. Late regrowth of pituitary adenomas after irradiation and/or surgery. Hazard function analysis. Cancer 1989;63:1308–1312.
Breen P, Flickinger JC, Kondziolka D, et al. Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control. J Neurosurg 1998;89:933–938.
van den Bergh AC, Hoving MA, Links TP, et al. Radiation optic neuropathy after external beam radiation therapy for acromegaly: report of two cases. Radiother Oncol 2003;68:101–103.
Goffman TE, Dewan R, Arakaki R, et al. Persistent or recurrent acromegaly. Long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy. Cancer 1992;69:271–275.
Grigsby PW, Stokes S, Marks JE, et al. Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 1988;15:1103–1110.
Gittoes NJ, Bates AS, Tse W, et al. Radiotherapy for non-function pituitary tumours. Clin Endocrinol (Oxf) 1998;48:331–337.
Sasaki R, Murakami M, Okamoto Y, et al. The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys 2000;47:1337–1345.
Dowsett RJ, Fowble B, Sergott RC, et al. Results of radiotherapy in the treatment of acromegaly: lack of ophthalmologic complications. Int J Radiat Oncol Biol Phys 1990;19:453–459.
Giustina A, Barkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000;85:526–529.
Gullu S, Keles H, Delibasi T, et al. Remission criteria for the follow-up of patients with acromegaly. Eur J Endocrinol 2004;150:465–471.
Clemmons DR, Chihara K, Freda PU, et al. Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm. J Clin Endocrinol Metab 2003;88:4759–4767.
Melmed S, Vance ML, Barkan AL, et al. Current status and future opportunities for controlling acromegaly. Pituitary 2002;5:185–196.
Melmed S, Sternberg R, Cook D, et al. A critical analysis of pituitary tumor shrinkage during primary medical therapy in acromegaly. J Clin Endocrinol Metab 2005;90:4405–4410.
Landolt AM, Haller D, Lomax N, et al. Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 2000;85:1287–1289.
Eastman RC, Gorden P, Glatstein E, et al. Radiation therapy of acromegaly. Endocrinol Metab Clin North Am 1992;21:693–712.
Minniti G, Jaffrain-Rea ML, Osti M, et al. The long-term efficacy of conventional radiotherapy in patients with GH-secreting pituitary adenomas. Clin Endocrinol (Oxf) 2005;62:210–216.
Biermasz NR, van Dulken H Roelfsema F. Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. J Clin Endocrinol Metab 2000;85:2476–2482.
Thalassinos NC, Tsagarakis S, Ioannides G, et al. Megavoltage pituitary irradiation lowers but seldom leads to safe GH levels in acromegaly: a long-term follow-up study. Eur J Endocrinol 1998;138:160–163.
Milker-Zabel S, Zabel A, Huber P, et al. Stereotactic conformal radiotherapy in patients with growth hormone-secreting pituitary adenoma. Int J Radiat Oncol Biol Phys 2004;59:1088–1096.
Williams M, van Seters AP, Hermans J, et al. Evaluation of the effects of radiotherapy on macroprolactinomas using the decline rate of serum prolactin levels as a dynamic parameter. Clin Oncol (R Coll Radiol) 1994;6:102–109.
Ozgen T, Oruckaptan HH, Ozcan OE, et al. Prolactin secreting pituitary adenomas: analysis of 429 surgically treated patients, effect of adjuvant treatment modalities and review of the literature. Acta Neurochir (Wien) 1999;141:1287–1294.
Littley MD, Shalet SM, Reid H, et al. The effect of external pituitary irradiation on elevated serum prolactin levels in patients with pituitary macroadenomas. Q J Med 1991;81:985–998.
Wallace EA, Holdaway IM. Treatment of macroprolactinomas at Auckland Hospital 1975-91. N Z Med J 1995;108:50–52.
Tsagarakis S, Grossman A, Plowman PN, et al. Megavoltage pituitary irradiation in the management of prolactinomas: long-term follow-up. Clin Endocrinol (Oxf) 1991;34:399–406.
Vicente A, Estrada J, de la Cuerda C, et al. Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. Acta Endocrinol (Copenh) 1991;125:470–474.
Plowman PN. Pituitary adenoma radiotherapy-when, who and how? Clin Endocrinol (Oxf) 1999;51:265–271.
Becker G, Kocher M, Kortmann RD, et al. Radiation therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol 2002;178:173–186.
Mahmoud-Ahmed AS, Suh JH. Radiation therapy for Cushing’s disease: a review. Pituitary 2002;5:175–180.
Melby JC. Therapy of Cushing [sic] disease: a consensus for pituitary microsurgery. Ann Int Med 1988;109:445–446.
Mampalam TJ, Tyrrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing [sic)] disease. A report of 216 cases. Ann Intern Med 1988;109:487–493.
Howlett TA, Plowman PN, Wass JA, et al. Megavoltage pituitary irradiation in the management of Cushing’s disease and Nelson’s syndrome: long-term follow-up. Clin Endocrinol (Oxf) 1989;31:309–323.
Nagesser SK, van Seters AP, Kievit J, et al. Treatment of pituitarydependent Cushing’s syndrome: long-term results of unilateral adrenalectomy followed by external pituitary irradiation compared to transsphenoidal pituitary surgery. Clin Endocrinol (Oxf) 2000;52:427–435.
Miller JW, Crapo L. The medical treatment of Cushing’s syndrome. Endocr Rev 1993;14:443–458.
Estrada J, Boronat M, Mielgo M, et al. The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med 1997;336:172–177.
Selch MT, Ahn E, Laskari A, Lee SP, et al. Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 2004;59:101–111.
Dufour H, Muracciole X, Metellus P, et al. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal? Neurosurgery 2001;48:285–294.
Milker-Zabel S, Zabel A, Schulz-Ertner D, et al. Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys 2005;61:809–816.
Jalali R, Loughrey C, Baumert B, et al. High precision focused irradiation in the form of fractionated stereotactic conformal radiotherapy (SCRT) for benign meningiomas predominantly in the skull base location. Clin Oncol (R Coll Radiol) 2002;14:103–109.
Debus J, Wuendrich M, Pirzkall A, et al. High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol 2001;19:3547–3553.
Uy NW, Woo SY, Teh BS, et al. Intensity-modulated radiation therapy (IMRT) for meningioma. Int J Radiat Oncol Biol Phys 2002;53:1265–1270.
Hetelekidis S, Barnes PD, Tao ML, et al. 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys 1993;27(2):189–195.
Kalapurakal JA. Radiation therapy in the management of pediatric craniopharyngiomas-a review. Childs Nerv Syst 2005;21(8–9):808–816.
Hasegawa T, Kondziolka D, Hadjipanayis CG, et al. Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 2004;54:813–820.
Glod J, Koch B, Myseros J, Breneman J, et al. Issues concerning the treatment of a child with a craniopharyngioma. Med Pediatr Oncol 2002;38:360–367.
Freeman CR, Patrocinio H, Farmer JP. Highly conformal radiotherapy for craniopharyngioma: (potentially) throwing the baby out with the bathwater. Med Pediatr Oncol 2003;40:340–341.
Selch MT, DeSalles AA, Wade M, et al. Initial clinical results of stereotactic radiotherapy for the treatment of craniopharyngiomas. Technol Cancer Res Treat 2002;1:51–59.
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Knisely, J.P., Sperduto, P.W. (2008). Pituitary and Pituitary Region Tumors: Fractionated Radiation Therapy Perspective. In: Chin, L.S., Regine, W.F. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-71070-9_28
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DOI: https://doi.org/10.1007/978-0-387-71070-9_28
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