Outcomes for Pituitary Adenoma Patients Treated with Linac-Based Stereotactic Radiosurgery and Radiotherapy: a Long Term Experience in Thailand

• DOI: 10.7314/apjcp.2015.16.13.5279
• Publication Date: 2015-10-14T02:18:11Z
• Authors: Putipun Puataweepong; Mantana Dhanachai; Ake Hansasuta; Somjai Dangprasert; Chomporn Sitathanee; Thiti Swangsilpa; Patamintita Vitoo...; Pornpan Yongvithi...
• Keywords: Adult; Male; Time Factors; Adolescent; Middle Aged; Prognosis; Radiosurgery; Thailand; Combined Modality Therapy; 3. Good health; Survival Rate; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Pituitary Neoplasms; Dose Fractionation, Radiation; Prospective Studies; Aged; Follow-Up Studies; Neoplasm Staging

The study analyzed the long term clinical outcomes of pituitary adenoma cases treated with the first Thailand installation of a dedicated Linac-based stereotactic radiation machine (X-Knife).A retrospective review of 115 consecutive pituitary adenoma patients treated with X-Knife at the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand from 1997 to 2003 was performed. Stereotactic radiosurgery (SRS) was selected for 21 patients (18%) including those with small tumors (≤3 cm) located ≥5 mm. from the optic apparatus, whereas the remaining 94 patients (82%) were treated with fractionated stereotactic radiotherapy (FSRT).With a median follow-up time of 62 months (range, 21-179), the six-year progression free survival was 95% (93% for SRS and 95% for FSRT). The overall hormone normalization at 3 and 5 years was 20% and 30%, respectively, with average time required for normalization of approximately 16 months for SRS and 20 months for FSRT. The incidence of new hypopituitarism was 10% in the SRS group and 9% in the FSRT group. Four patients (5%) developed optic neuropathy (1 in the SRS group and 3 in the FSRT group).Linac-based SRS and FSRT achieved similar high local control rates with few complications in pituitary adenoma cases. However, further well designed, randomized comparative studies between SRS versus FSRT particularly focusing on hormone normalization rates are required.