Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) by the Linear Accelerator (LINAC) in the management of pituitary adenomas: a retrospective analysis

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Copyright: Wilson, Peter John
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Abstract
Radiation has been used both as primary and adjuvant treatment for pituitary tumours for several decades, but since 1990 the Linear Accelerator (LINAC) has been in use at the Prince of Wales Hospital (POWH) to provide stereotactic radiosurgery (SRS). Where pituitary tumours are within 3 mm of the optic chiasm, fractionated stereotactic radiotherapy (FSRT) has been employed at POWH since 1995. The currently available literature has a clear bias towards Gamma Knife surgery (GK) series in regards to reporting results for SRS in pituitary tumours. The aim of this study was to not only provide an audit of the LINAC in pituitary adenomas at POWH, but also to add to the available literature. For the purposes of comparison, patients managed with conventional radiotherapy (CRT) prior to 1990 were included. A retrospective review of patients managed at POWH between 1971 and 2007 was performed with data collection ceased at the end of 2010. In all, 191 patients had SRS, 85 had FSRT and 108 had CRT. For the non-functioning pituitary adenomas (NFPA), 51 had SRS, 67 had FSRT and 53 had CRT. For acromegaly, 86 had SRS, 10 had FSRT and 25 had CRT. For prolactinomas, 13 had SRS, 5 had FSRT and 5 had CRT. In Cushing s disease, 36 had SRS, 1 had FSRT and 13 had CRT. Finally, in Nelson s syndrome, 5 had SRS, 2 had FSRT and 12 had CRT. Extensive data analysis was performed on each treatment category for each pathology, with primary endpoints tumour volume control and analysis of biochemical data for the functioning tumours. The secondary endpoint assessed was safety in regards to the creation of new hormonal deficits. Tertiary endpoints assessed included non-hormonal morbidity, as well as death (treatment related or otherwise) post treatment. Conclusions drawn from the study include overall excellent tumour volume control in all pituitary adenomas, with the exception of Nelson's syndrome where it was equivocal. For the functioning adenomas, biochemical control was strongest in acromegaly followed by prolactinomas. Biochemical results in Cushing s disease were less impressive. Overall treatment related morbidity was very low and consistent with previous literature.
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Author(s)
Wilson, Peter John
Supervisor(s)
Smee, Robert
Graham, Peter
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Publication Year
2013
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Thesis
Degree Type
Masters Thesis
UNSW Faculty
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