Effect of gamma knife radiosurgery on the treatment of pituitary adenoma on the function of the pituitary gland

When GKRS is used to treat pituitary adenomas, the photo-dose of the pituitary handle and pituitary glands is higher than the average point dose, and the pituitary function is prone to declineIDepartment of Neurosurgery, Radiation Oncology and Endocrinology, Virginia Health Sciences University, USA Jonathan Pomeraniec et alexplored the radiation-affected dose of the hypothalamus-pituitary axis and the effect of different exposure doses on the long-term clinical results of pituitary adenomas and the function of the pituitary glands through retrospective studiesThe article was published online in April 2019 by J Neurosurg- Excerpted from the article chapter
(Ref: Pomeraniec IJ, et alJNeurosurg2019 Apr 12:1-8doi: 10.3171/2019.1.JNS182296Thepituitary adenoma is a primary intracranial tumor common in adultsAutopsy and radiographic studies revealed a prevalence rate of 12%-23%Treatments include: medication, microsurgical excision, split radiation therapy, stereotactic radiosurgery (stereotactic radiosurgery, SRS)Gamma Knife Radio Surgical Therapy (GKRS), a type of SRS, has become an auxiliary treatment after the complete removal of pituitary adenomas and is a primary and acceptable and safe treatment for patients at high surgical riskThe tumor control rate after GKRS treatment is as high as 90%, and compared with conventional radiation, it can reduce the decline of prosthesis after radiotherapy, induces complications such as radioactive tumors, intra-cervical artery stenosis, stroke and neurocognitive function The clinical advantage is to target tumor tissue precisely, and normal brain structures may be protected from unnecessary radiation However, patients after GKRS can still have hypoglycity, which may be related to the radiation dose of the hypothalamus-pituitary axis It has been pointed out that when GKRS is used to treat pituitary adenomas, the dose of the pituitary handle and pituitary glandist is higher than the average point dose and is prone to decline in the function of the pituitary gland I Department of Neurosurgery, Radiation Oncology and Endocrinology, Virginia Health Sciences University, USA Jonathan Pomeraniec et al explored the radiation-affected dose of the hypothalamus-pituitary axis and the effect of different exposure doses on the long-term clinical results of pituitary adenomas and the function of the pituitary glands through retrospective studies The article was published online in April 2019 by J Neurosurg the study included 236 patients treated with GKRS between 1998 and 2015, and reviewed the follow-up results of clinical symptoms, imaging data, endocrine status, vision and other neurological functions, surgical records, treatment methods, pathology reports, and postoperative neurological function, endocrine status, vision and MRI imaging in the saddle area GKRS treatment was conducted on the same day as an mrI test as an imaging baseline for follow-up Postoperative pituitary hormone levels are lower than normal and require drug control, defined as a new decline in the function of the drooping function A 15% increase or decrease in tumor volume in postoperative imaging is defined as tumor change Select 14 different irradiation points along the hypothalamus-pituitary axis (Figure 1), of which 3 on the left and right side of the hypothalamus, 3 in the pituitary body and 5 pituitary handles; The use of Leksell GammaPlan software to analyze the effects of radiation doseon on tumor control and endocrine disorders was used The following variables were determined by the binary logical regression model and the Cox proportional hazard regression model: sex, age at GKRS, edge dose of adenoma, tumor volume, and point dose and maximum dose of exposure in different parts of the hypothalamus, pituitary shank and normal pituitary body; Figure 1 Location distribution of the hypothalamus, pituitary handle, and pituitary point dose detection 236 cases of pituitary adenoma, 46.6% were male and 53.4% were female, the average age was 49.6 years, the follow-up period was 12-201, with an average of 42.9 months, and the tumor pathology type was 41.5% of the non-functional adenoma, 28.4% actuatorid adenoma and 24.6% were growth hormone adenomas The dose parameters of the anatomical structure of the saddle area are shown in Table 1 during GKRS treatment Table 1. The dose parameters of the anatomical structure of the saddle area of GKRS results showed that 114 patients with pituitary adenomahadic disorderhaded function declined prior to GKRS treatment After GKRS treatment, 44 new endocrine cases decreased The decline in new endocrine function was 2-157 months after GKRS treatment, with an average of 21 months The first to occur a decrease in growth hormone secretion, which occurred 5-32 months after GKRS treatment, an average of 19.2 months, followed by a decrease in thyroxinhormone secretion, which occurred 4-42 months after GKRS treatment, an average of 20.7 months 2-52 months after GKRS treatment, an average of 21.6 months, there was a decrease in gonadotropin secretion function, and the stilettos of ACTH secretion decreased at the latest, 15-61 months after GKRS treatment, an average of 29 months After GKRS treatment, 9 patients developed visual impairment The decline in endocrine function was not related to the control status of tumor growth The tumor control rate was 90.3% at 42 months of follow-up The analysis of the logical regression model shows that the dose of the gKRS pituitary shank-pituitary gland is closely related to the decline of the pituitary function Increased age in patients is also associated with decreased endocrine function , benign pituitary adenomas are closely related to the surrounding structure, as well as the risk of potential hormonal secretion disorders, which can lead to serious complications GKRS provides safe and effective treatments for surgically residual adenomas or tumors that are not suitable for surgery However, after GKRS treatment, the pituitary handle - normal pituitary body affected by the dose, can appear late-occurrence drooping function decline, must be given great attention.