Radiotherapy for pituitary adenomas: long-term outcome and complicationsRadiotherapy for pituitary adenomas: long-term outcome and complications
- Other Titles
- Radiotherapy for pituitary adenomas: long-term outcome and complications
- Authors
- 임채홍; 양대식; 박영제; 윤원섭; 이정애; 김철용
- Issue Date
- 2011
- Publisher
- 대한방사선종양학회
- Keywords
- Pituitary adenoma; Radiotherapy; Prognostic factors; Complications
- Citation
- Radiation oncology journal, v.29, no.3, pp.156 - 163
- Indexed
- KCI
- Journal Title
- Radiation oncology journal
- Volume
- 29
- Number
- 3
- Start Page
- 156
- End Page
- 163
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/114140
- ISSN
- 1229-8719
- Abstract
- Purpose: To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas.
Materials and Methods: We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The defi nition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others,rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic signifi cance in tumor control.
Results: Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was signifi cant prognostic factor (p = 0.042) and cavernous sinus extension was marginally signifi cant factor (p = 0.054) for adverse local control. All other factors were not signifi cant. In multivariate analysis, hormone secretion and gender were signifi cant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia,acromegaly, and Cushing’s disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing’s disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation.
Conclusion: EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.
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