Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol
ObjectiveNonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established in the literature for single-fraction frame-based radiosurgery, but mature outcom...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1519445/full |
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| author | Akrita Bhatnagar Monica Pernia Marin Jonathan W. Lischalk Min Ji Koh Siviero Agazzi Simeng Suy Brent T. Harris Susmeeta T. Sharma Edward Aulisi Amjad Anaizi Mohamed H. Khattab Walter C. Jean Walter C. Jean Sean P. Collins Brian T. Collins |
| author_facet | Akrita Bhatnagar Monica Pernia Marin Jonathan W. Lischalk Min Ji Koh Siviero Agazzi Simeng Suy Brent T. Harris Susmeeta T. Sharma Edward Aulisi Amjad Anaizi Mohamed H. Khattab Walter C. Jean Walter C. Jean Sean P. Collins Brian T. Collins |
| author_sort | Akrita Bhatnagar |
| collection | DOAJ |
| description | ObjectiveNonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established in the literature for single-fraction frame-based radiosurgery, but mature outcomes are lacking for fractionated frameless radiosurgery. We report our institution’s 5-year efficacy and toxicity results for unfavorable nonfunctioning pituitary macroadenoma patients treated with 5-fraction robotic radiosurgery.MethodsBetween 2010 and 2020, patients who completed 5-fraction robotic radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem, or pituitary gland). Local control was calculated using the Kaplan–Meier method.ResultsTwenty predominantly female patients (60%), ages 21–77 (median: 53 years), were included in this study. All underwent primary resection at the time of diagnosis. The indication for radiosurgery was tumor progression (n = 14, 70%) or residual tumor after subtotal resection (n = 6, 30%). Eighty-five percent of patients treated with radiosurgery (n = 17) had cavernous sinus involvement. Median GTV was 3.4 cm3 (range: 0.3–20.8 cm3), and 40% of the tumors had suprasellar extension. A mean dose of 28.8 Gy (range: 25–30 Gy) was delivered to a median isodose line of 80% (range: 75%–89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0–25.0 Gy). Acute toxicity was minimal with eight patients (40%) developing short-lived headaches and one patient (5%) developing a brief ipsilateral sixth nerve palsy. There was no late radiation-induced neurologic or optic dysfunction identified in this cohort. At a median follow-up of 5 years, local control was 94%. There was one in-field failure pathologically confirmed following surgery for pituitary hemorrhage and two radiographically confirmed out-of-field failures in patients with larger tumors (>20 cc).ConclusionsThe treatment of unfavorable nonfunctioning pituitary macroadenoma with 5-fraction robotic radiosurgery provides excellent local control to date, with acceptable toxicity. However, tumors with GTVs greater than 20 cc may still require conventionally fractionated treatment with a margin to optimize local control. |
| format | Article |
| id | doaj-art-86db6655951d4166936624894650b522 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-86db6655951d4166936624894650b5222025-02-04T05:28:14ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-02-011510.3389/fonc.2025.15194451519445Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocolAkrita Bhatnagar0Monica Pernia Marin1Jonathan W. Lischalk2Min Ji Koh3Siviero Agazzi4Simeng Suy5Brent T. Harris6Susmeeta T. Sharma7Edward Aulisi8Amjad Anaizi9Mohamed H. Khattab10Walter C. Jean11Walter C. Jean12Sean P. Collins13Brian T. Collins14Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United StatesDivision of Neuro-Oncology, Columbia University Irving Medical Center, New York, NY, United StatesDepartment of Radiation Oncology, Perlmutter Cancer Center, New York University (NYU), Langone, New York, NY, United StatesDepartment of Radiation Medicine, Georgetown University Hospital, Washington, DC, United StatesDepartment of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United StatesDepartment of Radiation Medicine, Georgetown University Hospital, Washington, DC, United StatesDepartment of Pathology and Neurology, Georgetown University Hospital, Washington, DC, United StatesDepartment of Endocrinology, MedStar Washington Hospital Center, Washington, DC, United StatesDepartment of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, United StatesDepartment of Neurosurgery, Georgetown University Hospital, Washington, DC, United StatesDepartment of Radiation Oncology, University of South Florida, Tampa, FL, United StatesDepartment of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States0Division of Neurosurgery, Lehigh Valley Fleming Neuroscience Institute, Allentown, PA, United StatesDepartment of Radiation Oncology, University of South Florida, Tampa, FL, United StatesDepartment of Radiation Oncology, University of South Florida, Tampa, FL, United StatesObjectiveNonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established in the literature for single-fraction frame-based radiosurgery, but mature outcomes are lacking for fractionated frameless radiosurgery. We report our institution’s 5-year efficacy and toxicity results for unfavorable nonfunctioning pituitary macroadenoma patients treated with 5-fraction robotic radiosurgery.MethodsBetween 2010 and 2020, patients who completed 5-fraction robotic radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem, or pituitary gland). Local control was calculated using the Kaplan–Meier method.ResultsTwenty predominantly female patients (60%), ages 21–77 (median: 53 years), were included in this study. All underwent primary resection at the time of diagnosis. The indication for radiosurgery was tumor progression (n = 14, 70%) or residual tumor after subtotal resection (n = 6, 30%). Eighty-five percent of patients treated with radiosurgery (n = 17) had cavernous sinus involvement. Median GTV was 3.4 cm3 (range: 0.3–20.8 cm3), and 40% of the tumors had suprasellar extension. A mean dose of 28.8 Gy (range: 25–30 Gy) was delivered to a median isodose line of 80% (range: 75%–89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0–25.0 Gy). Acute toxicity was minimal with eight patients (40%) developing short-lived headaches and one patient (5%) developing a brief ipsilateral sixth nerve palsy. There was no late radiation-induced neurologic or optic dysfunction identified in this cohort. At a median follow-up of 5 years, local control was 94%. There was one in-field failure pathologically confirmed following surgery for pituitary hemorrhage and two radiographically confirmed out-of-field failures in patients with larger tumors (>20 cc).ConclusionsThe treatment of unfavorable nonfunctioning pituitary macroadenoma with 5-fraction robotic radiosurgery provides excellent local control to date, with acceptable toxicity. However, tumors with GTVs greater than 20 cc may still require conventionally fractionated treatment with a margin to optimize local control.https://www.frontiersin.org/articles/10.3389/fonc.2025.1519445/fullradiosurgeryfractionated stereotactic radiosurgerynonfunctioning pituitary adenomalocal controlCyberKnife |
| spellingShingle | Akrita Bhatnagar Monica Pernia Marin Jonathan W. Lischalk Min Ji Koh Siviero Agazzi Simeng Suy Brent T. Harris Susmeeta T. Sharma Edward Aulisi Amjad Anaizi Mohamed H. Khattab Walter C. Jean Walter C. Jean Sean P. Collins Brian T. Collins Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol Frontiers in Oncology radiosurgery fractionated stereotactic radiosurgery nonfunctioning pituitary adenoma local control CyberKnife |
| title | Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol |
| title_full | Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol |
| title_fullStr | Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol |
| title_full_unstemmed | Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol |
| title_short | Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol |
| title_sort | fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma 5 year outcomes from a single institution protocol |
| topic | radiosurgery fractionated stereotactic radiosurgery nonfunctioning pituitary adenoma local control CyberKnife |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1519445/full |
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