Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis

Paolo Palmisciano; Christian Ogasawara; Maya Ogasawara; Gianluca Ferini; Gianluca Scalia; Ali S Haider; Othman Bin Alamer; Maurizio Salvati; Giuseppe E Umana

doi:10.1007/s11102-022-01219-x

Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis

Pituitary. 2022 Jun;25(3):404-419. doi: 10.1007/s11102-022-01219-x. Epub 2022 Mar 29.

Authors

Paolo Palmisciano¹, Christian Ogasawara², Maya Ogasawara³, Gianluca Ferini⁴, Gianluca Scalia⁵, Ali S Haider⁶, Othman Bin Alamer⁷, Maurizio Salvati⁸, Giuseppe E Umana⁹

Affiliations

¹ Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA.
² John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA.
³ University of California, Berkeley, CA, USA.
⁴ Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy.
⁵ Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy.
⁶ Texas A&M University College of Medicine, Houston, TX, USA.
⁷ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁸ Department of Neurosurgery, IRCCS, Sapienza University of Rome, NeuromedPozzilli, Italy.
⁹ Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy. umana.nch@gmail.com.

PMID: 35349010
DOI: 10.1007/s11102-022-01219-x

Abstract

Purpose: Gamma Knife radiosurgery (GKRS) is feasible for pituitary adenomas, but post-surgery GKRS may cause severe hormone deficits. We reviewed the literature on primary GKRS for pituitary adenoma focusing on radiation-induced hormone deficiencies.

Methods: PubMed, Web-of-Science, Scopus, and Cochrane were searched upon the PRISMA guidelines to include studies describing primary GKRS for pituitary adenomas. Pooled-rates of GKRS-induced hormone deficiencies and clinical-radiological responses were analyzed with a random-effect model meta-analysis.

Results: We included 24 studies comprising 1381 patients. Prolactinomas were the most common (34.2%), and 289 patients had non-functioning adenomas (20.9%). Median tumor volume was 1.6cm³ (range, 0.01-31.3), with suprasellar extension and cavernous sinus invasion detected in 26% and 31.1% cases. GKRS was delivered with median marginal dose 22.6 Gy (range, 6-49), maximum dose 50 Gy (range, 25-90), and isodose line 50% (range, 9-100%). Median maximum point doses were 9 Gy (range, 0.5-25) to the pituitary stalk, 7 Gy (range, 1-38) to the optic apparatus, and 5 Gy (range, 0.4-12.3) to the optic chiasm. Pooled 5 year rates of endocrine normalization and local tumor control were 48% (95%CI 45-51%) and 97% (95%CI 95-98%). 158 patients (11.4%) experienced endocrinopathies at a median of 45 months (range, 4-187.3) after GKRS, with pooled 5-year rates of 8% (95%CI 6-9%). GKRS-induced hormone deficiencies comprised secondary hypothyroidism (42.4%) and hypogonadotropic hypogonadism (33.5%), with panhypopituitarism reported in 31 cases (19.6%).

Conclusion: Primary GKRS for pituitary adenoma may correlate with lower rates of radiation-induced hypopituitarism (11.4%) than post-surgery GKRS (18-32%). Minimal doses to normal pituitary structures and long-term endocrine follow-up are of primary importance.

Keywords: Endocrine disorders; Gamma knife; Hypopituitarism; Pituitary adenoma; Radiation-induced complications; Radiosurgery.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adenoma* / pathology
Adenoma* / radiotherapy
Adenoma* / surgery
Follow-Up Studies
Hormones
Humans
Pituitary Neoplasms* / pathology
Pituitary Neoplasms* / radiotherapy
Pituitary Neoplasms* / surgery
Radiosurgery* / adverse effects
Retrospective Studies
Treatment Outcome

Substances

Hormones