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Pituitary Adenomas

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CyberKnife NeuroRadiosurgery

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Abstract

Radiation therapy is considered when residual or recurrent tumors after surgery invade the cavernous sinus or in cases where repeated surgery has resulted in fibrosis and inoperability for non-functioning pituitary adenoma. Radiotherapy is also considered for patients with excessive hormone secretion who do not respond well to surgery and pharmacotherapy or cases requiring tumor control for the suppression of visual disorders for functioning pituitary adenomas.

Due to the proximity of organs at risk, such as the optic nerve, optic chiasm, and brain stem, the use of stereotactic irradiation is increasing. The sparing of normal tissue, in particular of late response tissue presumably with a low α/β ratio (<3 Gy), such as the optical pathways and the brain stem, can be more efficient by using lower daily doses with fractionated radiation compared to stereotactic radiosurgery.

Hypofractioned stereotactic radiotherapy with CyberKnife for non-functioning pituitary adenoma appears to be useful to protect the optic nerve and neuroendocrine function, particularly for tumors located near the optic pathways and large tumors.

CyberKnife hypofractioned stereotactic radiotherapy is also safe and effective when evaluated by imaging results of functioning pituitary adenoma. However, it may be difficult to meet hormonal criteria (Cortina consensus) in most symptomatic patients with stereotactic radiotherapy alone. Further investigation into optimal treatments is warranted.

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Acknowledgments

The authors are grateful to Drs. Seiji Ohta, Koshi Tatewaki, Naoki Yokota, Kengo Sato, and Mitsuhiro Inoue, and the staffs at the Yokohama CyberKnife Center for their valuable help.

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Authors and Affiliations

  1. Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan

    Hiromitsu Iwata

  2. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Hiromitsu Iwata & Yuta Shibamoto

Authors
  1. Hiromitsu Iwata
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  2. Yuta Shibamoto
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Corresponding author

Correspondence to Hiromitsu Iwata .

Editor information

Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Iwata, H., Shibamoto, Y. (2020). Pituitary Adenomas. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_25

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