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. 2022 Dec;25(6):948-958.
doi: 10.1007/s11102-022-01279-z. Epub 2022 Oct 6.

The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases

Zhishuo Wei  1 , Sila Yavan  1 , Hansen Deng  1 , Arka N Mallela  1 , Zachary C Gersey  1 , Rimsha K Shariff  2   3 , Pouneh K Fazeli  3 , Ajay Niranjan  1 , L Dade Lunsford  1 , Hussam Abou-Al-Shaar  4
Affiliations

The role of stereotactic radiosurgery in the multidisciplinary management of pituitary metastases

Zhishuo Wei et al. Pituitary. 2022 Dec.

Abstract

Purpose: This study evaluates the role and outcomes of Gamma Knife radiosurgery (GKRS) in the management of pituitary metastases.

Methods: The records of brain metastases patients who underwent GKRS at the University of Pittsburgh Medical Center during the 10-year interval of 2010-2020 were systematically reviewed. Outcome measures included patient survival, tumor control rate, pituitary hormonal outcomes, visual outcomes, adverse radiation effects (AREs), and need for adjuvant therapy.

Results: Eighteen patients with pituitary metastases (eight male; median age of 65.5 years) had sufficient clinical follow-up for analysis. The most common primary cancers were non-small cell lung cancer (n = 6) and breast cancer (n = 4). Patients presented with headache (n = 9) and visual difficulties (n = 6). One patient underwent resection before GKRS. The median tumor volume was 0.78 cc (range 0.04-6.42 cc). The median overall survival after GKRS was 6.5 months (range 0.5-58 months). The overall survival after GKRS at 3-, 6-, and 12-months were 72.2%, 50.0% and 38.9%, respectively. The tumor control rate was 94.4%. One patient had further progression that required additional GKRS. None of the patients developed AREs after GKRS.

Conclusion: GKRS is an effective treatment modality for the multidisciplinary management of patients with pituitary metastases. This minimally-invasive strategy is associated with optimal tumor control rate and low risk to adjacent optic nerves or neurovascular structures.

Keywords: Adverse radiation effects; Brain metastases; Gamma Knife radiosurgery; Hormonal outcomes; Pituitary gland; Pituitary metastases.

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