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KMID : 0942820030020020062
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Journal of Korean Brain Tumor Society
2003 Volume.2 No. 2 p.62 ~ p.70
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Radiosurgery for Pituitary Adenomas
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Lim Young-Jin
Park Sung-Hun
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Abstract
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Pituitary adenomas are relatively common tumors that account for 8-15% of all primary intracranial tumors. In the majority of cases, these tumors are associated with pathological hormonal sectretion. There are two main aims of treatment in respect of pituitary adenomas. The first is to remove a neoplastic process, and the second aim is to control the overproduction of hormone. In these tumors, the first therapeutic option is microsurgery. Despite advances in microsurgical management, postoperative recurrence may occur because of tumor invasion into surrounding structures such as the cavernous sinus. In such cases, conventional fractionated radiotherapy has been known to be effective, but it also carries a significant risk for panhypopituitarism or visual disturbances. Heavy charged particle irradiation taking advantage of the Bragg-peak effect may be also effective. However, proliferation of charged particle irradiation has been restricted by the cost and limited availability of this technology. Stereotactic radiosurgery of pituitary adenoma gained popularity with the introduction and widespread usage of Leksell Gamma Unit. Radiosurgery may be indicated as a secondline therapy after surgery if the tumor volume is small and the distance of the adenoma surface to the optic pathway is sufficiently broad to enable a safe procedure. Radiosurgery can be a safe salvage therapy for recurrent or remnant tumors with effectiveness but with less risk of causing radiation induced injury to the surrounding structures. For the better results, radiosurgical dosimetry is important. It would seem that if the aim of treatment is to halt growth, then an edge dose of 12 to 15Gy is adequate. However, if the aim is to cure an endocrinopathy then the required dose is probably nearer to 35Gy. After radiosurgery, tumor control rate is excellent than endocrine secretion normalization. To clarify the role of radiosurgery for treatment of pituitary adenomas, the author has reviewed related literature, and present the radiosurgical dosimetry, the clinical treatent results and complications.
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KEYWORD
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Pituitary adenoma, Microsurgery, Conventional fractionated radiotherapy, Radiosurgery
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