Stereotactic conformal radiotherapy for pituitary adenomas: Technique and preliminary experience

R. Jalali, Michael Brada, Julian R Perks, A. P. Warrington, D. Traish, L. Burchell, H. McNair, D. G T Thomas, S. Robinson, D. G. Johnston

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Stereotactic conformal radiotherapy (SCRT) is a high precision technique of fractionated radiotherapy which ensures accurate delivery of radiation with reduction in the volume of normal tissue irradiated as compared to conventional external beam radiotherapy. We describe the technique and preliminary experience of SCRT in patients with residual and recurrent pituitary adenomas. PATIENTS AND METHODS: Between February 1995 and March 1999, 22 patients (mean age: 45.3, range: 20-67 years) with residual or recurrent pituitary adenomas (13 nonfunctioning, nine secretory) were treated with SCRT. All were immobilized in a relocatable Gill-Thomas-Cosman (GTC) frame and tumour was localized on a postcontrast planning computerized tomography (CT) and MRI scan. The gross tumour volume (GTV) and the critical structures were outlined on contiguous 2-3 mm separated slices. A margin of 5 mm (12 patients) to 10 mm (10 patients) was grown around GTV in three-dimensions (3-D) to generate the planning target volume (PTV). The treatment was delivered by three (five patients) and four (17 patients) maximally separated conformal fixed fields with each field conformed to the-shape of the tumour using customized lead alloy blocks (19 patients) or multileaf collimator (three patients). The patients were treated on a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions (18 patients) and 50 Gy in 30 fractions (four patients). RESULTS: The technique of SCRT has become a part of the routine work of the radiotherapy department. The treatment was well tolerated with minimal acute toxicity. One patient developed transient quadrantanopia 2 weeks after treatment with full recovery after a short course of corticosteroids. One patient had a transient visual deterioration 7 months after treatment due to cystic degeneration of the tumour which fully recovered following surgical decompression. Nine of the 15 patients presenting with visual impairment had improvement after treatment and the visual status remained stable in all others. One patient with acromegaly and one with a prolactinoma achieved normalization of elevated hormonal abnormality four and 10 months after SCRT, respectively. The remaining seven patients with a secretory adenoma had declining hormone levels at last follow-up. Newly initiated hormone replacement therapy was required in five patients. At a median follow-up of 9 months (range 1-44 months), the 1 and 2 year actuarial progression free and overall survival were 100%. CONCLUSION: Stereotactic conformal radiotherapy is a high precision technique suitable for the treatment of pituitary adenomas requiring radiotherapy. Preliminary results suggest effective tumour control and low toxicity within the range expected for conventional external beam radiotherapy. While the technique is of potential benefit in reducing the volume of normal brain irradiated, the advantages in terms of sustained tumour control and reduced toxicity over conventional radiotherapy need to be demonstrated in long-term prospective studies.

Original languageEnglish (US)
Pages (from-to)695-702
Number of pages8
JournalClinical Endocrinology
Volume52
Issue number6
DOIs
StatePublished - 2000
Externally publishedYes

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Conformal Radiotherapy
Pituitary Neoplasms
Radiotherapy
Neoplasms
Tumor Burden
Therapeutics
Stereotaxic Techniques
Hemianopsia
Prolactinoma
Surgical Decompression
Particle Accelerators
Acromegaly

ASJC Scopus subject areas

  • Endocrinology

Cite this

Stereotactic conformal radiotherapy for pituitary adenomas : Technique and preliminary experience. / Jalali, R.; Brada, Michael; Perks, Julian R; Warrington, A. P.; Traish, D.; Burchell, L.; McNair, H.; Thomas, D. G T; Robinson, S.; Johnston, D. G.

In: Clinical Endocrinology, Vol. 52, No. 6, 2000, p. 695-702.

Research output: Contribution to journalArticle

Jalali, R, Brada, M, Perks, JR, Warrington, AP, Traish, D, Burchell, L, McNair, H, Thomas, DGT, Robinson, S & Johnston, DG 2000, 'Stereotactic conformal radiotherapy for pituitary adenomas: Technique and preliminary experience', Clinical Endocrinology, vol. 52, no. 6, pp. 695-702. https://doi.org/10.1046/j.1365-2265.2000.00967.x
Jalali, R. ; Brada, Michael ; Perks, Julian R ; Warrington, A. P. ; Traish, D. ; Burchell, L. ; McNair, H. ; Thomas, D. G T ; Robinson, S. ; Johnston, D. G. / Stereotactic conformal radiotherapy for pituitary adenomas : Technique and preliminary experience. In: Clinical Endocrinology. 2000 ; Vol. 52, No. 6. pp. 695-702.
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T2 - Technique and preliminary experience

AU - Jalali, R.

AU - Brada, Michael

AU - Perks, Julian R

AU - Warrington, A. P.

AU - Traish, D.

AU - Burchell, L.

AU - McNair, H.

AU - Thomas, D. G T

AU - Robinson, S.

AU - Johnston, D. G.

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N2 - OBJECTIVE: Stereotactic conformal radiotherapy (SCRT) is a high precision technique of fractionated radiotherapy which ensures accurate delivery of radiation with reduction in the volume of normal tissue irradiated as compared to conventional external beam radiotherapy. We describe the technique and preliminary experience of SCRT in patients with residual and recurrent pituitary adenomas. PATIENTS AND METHODS: Between February 1995 and March 1999, 22 patients (mean age: 45.3, range: 20-67 years) with residual or recurrent pituitary adenomas (13 nonfunctioning, nine secretory) were treated with SCRT. All were immobilized in a relocatable Gill-Thomas-Cosman (GTC) frame and tumour was localized on a postcontrast planning computerized tomography (CT) and MRI scan. The gross tumour volume (GTV) and the critical structures were outlined on contiguous 2-3 mm separated slices. A margin of 5 mm (12 patients) to 10 mm (10 patients) was grown around GTV in three-dimensions (3-D) to generate the planning target volume (PTV). The treatment was delivered by three (five patients) and four (17 patients) maximally separated conformal fixed fields with each field conformed to the-shape of the tumour using customized lead alloy blocks (19 patients) or multileaf collimator (three patients). The patients were treated on a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions (18 patients) and 50 Gy in 30 fractions (four patients). RESULTS: The technique of SCRT has become a part of the routine work of the radiotherapy department. The treatment was well tolerated with minimal acute toxicity. One patient developed transient quadrantanopia 2 weeks after treatment with full recovery after a short course of corticosteroids. One patient had a transient visual deterioration 7 months after treatment due to cystic degeneration of the tumour which fully recovered following surgical decompression. Nine of the 15 patients presenting with visual impairment had improvement after treatment and the visual status remained stable in all others. One patient with acromegaly and one with a prolactinoma achieved normalization of elevated hormonal abnormality four and 10 months after SCRT, respectively. The remaining seven patients with a secretory adenoma had declining hormone levels at last follow-up. Newly initiated hormone replacement therapy was required in five patients. At a median follow-up of 9 months (range 1-44 months), the 1 and 2 year actuarial progression free and overall survival were 100%. CONCLUSION: Stereotactic conformal radiotherapy is a high precision technique suitable for the treatment of pituitary adenomas requiring radiotherapy. Preliminary results suggest effective tumour control and low toxicity within the range expected for conventional external beam radiotherapy. While the technique is of potential benefit in reducing the volume of normal brain irradiated, the advantages in terms of sustained tumour control and reduced toxicity over conventional radiotherapy need to be demonstrated in long-term prospective studies.

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