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Hypofractionated stereotactic radiosurgery for pituitary metastases

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Abstract

Pituitary metastases (PMs) are uncommon, representing only 1% of pituitary lesions. The diagnosis of PMs can be challenging and an optimal management remains to be determined. Here, we present a pilot clinical study on the efficacy and safety of hypofractionated stereotactic radiosurgery (SRS) with an optimized dosimetric plan in treating PMs. Between June 2013 and December 2014, seven consecutive patients (4 men and 3 women; median age 62 years) had been diagnosed with PMs based on their characteristic clinical and radiological features and subsequently treated using hypofractionated SRS. Primary cancers originated from the lung (n = 5) or the breast (n = 2). All patients presented with diabetes insipidus (DI). Anterior pituitary and visual dysfunction were combined in 4 and 3 patients, respectively. On magnetic resonance imaging (MRI), PMs involved the pituitary stalk and/or the posterior lobe in all patients. SRS of a cumulative marginal dose 31 Gy with dose-volume constraints for the optic apparatus was delivered in 5 daily fractions. As results, tumor was locally controlled in all patients with substantial responses on MRI (including complete remission in 4 patients). The median survival time was 14 months (range, 6–24 months) after SRS. DI and visual dysfunction improved in all patients, although anterior pituitary dysfunction did not recover. No patients experienced any deterioration in visual, pituitary, or other cranial nerve functions. These results suggest a promising role of hypofractionated SRS in treating PMs in terms of both tumor control and functional outcomes.

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Acknowledgements

The authors are grateful to Professor Byungchul Cho, PhD, Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine.

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Authors and Affiliations

  1. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Haemin Chon, Do Hoon Kwon, Chang Jin Kim & Young Hyun Cho

  2. Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    KyoungJun Yoon, Do Hoon Kwon, Chang Jin Kim & Young Hyun Cho

  3. Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Min-Seon Kim

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  1. Haemin Chon
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  2. KyoungJun Yoon
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  3. Do Hoon Kwon
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  4. Chang Jin Kim
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Correspondence to Young Hyun Cho.

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Chon, H., Yoon, K., Kwon, D.H. et al. Hypofractionated stereotactic radiosurgery for pituitary metastases. J Neurooncol 132, 127–133 (2017). https://doi.org/10.1007/s11060-016-2346-z

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  • DOI: https://doi.org/10.1007/s11060-016-2346-z

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