Frequency, pattern, and outcome of recurrences after gamma knife radiosurgery for pituitary adenomas

Gamma Knife radiosurgery is often used in pituitary adenomas. Aim of our study is to describe the characteristics and long-term outcome of patients with adenoma recurrence after Gamma Knife radiosurgery. We conducted a retrospective analysis of patients with pituitary adenoma treated by Gamma Knife radiosurgery between 1994 and 2014. Tumor recurrence was labeled as "in field" when the tumor growth occurred adjacent or within the prescribed isodose, whereas it was classified as "out of field" when the tumor growth occurred outside the prescribed isodose. Five hundred forty-three patients were included, 272 (50.1 %) had a nonfunctioning pituitary adenoma (NFPA) and 271 (49.9 %) patients had a hormone secreting-pituitary adenoma. The median follow-up after GKRS was 78 months (IQR, 36-125 months). Thirty-nine patients (7.2 %) had recurrence of disease and it was more frequent in patients with NFPA than in patients with hormone secreting adenomas (9.6 % vs. 4.8 %). The 10-yr progression-free survival in patients with NFPA was 78.7 % (95 % CI 69.5 - 87.9 %), as compared with 93.3 % (95 % CI 89.3 - 97.3 %; p < 0.01) in hormone secreting adenomas. Tumor recurrence was "in field" in 17 cases (43.6 %) and "out of field" in 22 cases (56.4 %). Seven of the 39 patients with recurrence died despite further treatments. Six of these patients had an "in field" recurrence. Recurrence of a pituitary adenoma after GKRS may occur several years after initial treatment. Distinction between "in field" and "out of field" tumor recurrence probably reflects two different pathophysiological mechanisms and may have prognostic importance.