Stereotactic radiosurgery for non-functioning pituitary adenomas: Meta-analysis and International Stereotactic Radiosurgery Society practice opinion

Rupesh Kotecha, Arjun Sahgal, Muni Rubens, Antonio De Salles, Laura Fariselli, Bruce E. Pollock, Marc Levivier, Lijun Ma, Ian Paddick, Jean Regis, Jason Sheehan, Shoji Yomo, John H. Suh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This systematic review reports on outcomes and toxicities following stereotactic radiosurgery (SRS) for non-functioning pituitary adenomas (NFAs) and presents consensus opinions regarding appropriate patient management. Methods: Using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review was performed from articles of ≥10 patients with NFAs published prior to May 2018 from the Medline database using the key words "radiosurgery"and "pituitary"and/or "adenoma."Weighted random effects models were used to calculate pooled outcome estimates. Results: Of the 678 abstracts reviewed, 35 full-text articles were included describing the outcomes of 2671 patients treated between 1971 and 2017 with either single fraction SRS or hypofractionated stereotactic radiotherapy (HSRT). All studies were retrospective (level IV evidence). SRS was used in 27 studies (median dose: 15 Gy, range: 5-35 Gy) and HSRT in 8 studies (median total dose: 21 Gy, range: 12-25 Gy, delivered in 3-5 fractions). The 5-year random effects local control estimate after SRS was 94% (95% CI: 93.0-96.0%) and 97.0% (95% CI: 93.0-98.0%) after HSRT. The 10-year local control random effects estimate after SRS was 83.0% (95% CI: 77.0-88.0%). Post-SRS hypopituitarism was the most common treatment-related toxicity observed, with a random effects estimate of 21.0% (95% CI: 15.0-27.0%), whereas visual dysfunction or other cranial nerve injuries were uncommon (range: 0-7%). Conclusions: SRS is an effective and safe treatment for patients with NFAs. Encouraging short-term data support HSRT for select patients, and mature outcomes are needed before definitive recommendations can be made. Clinical practice opinions were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Original languageEnglish
Pages (from-to)318-332
Number of pages15
JournalNeuro-Oncology
Volume22
Issue number3
DOIs
Publication statusPublished - Mar 5 2020

Keywords

  • consensus
  • ISRS
  • non-functioning
  • pituitary adenomas
  • radiation therapy
  • radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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