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Related Experiment Video

Updated: Jun 13, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Long-Term Outcomes After CyberKnife Radiosurgery for Nonfunctioning Pituitary Adenomas.

Nathan Wei1, Kevin Gunawan2, Chiao-Ling Tsai3

  • 1Department of Neurosurgery, National Taiwan University Hospital, Taipei , Taiwan.

Neurosurgery
|September 12, 2024
PubMed
Summary

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Stereotactic radiosurgery (SRS) effectively controls nonfunctioning pituitary adenomas (NFPAs) with high long-term tumor control rates. While generally safe, careful consideration of radiation dose is needed to minimize risks of new-onset hypopituitarism.

Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Endocrinology

Background:

  • Nonfunctioning pituitary adenomas (NFPAs) are often managed with stereotactic radiosurgery (SRS).
  • Previous studies on SRS for NFPAs have been limited by small sample sizes and short follow-up periods.
  • Long-term outcomes of SRS for NFPAs require further investigation.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of SRS for managing NFPAs.
  • To assess tumor control rates, incidence of new-onset hypopituitarism, and visual outcomes after SRS.
  • To identify risk factors associated with adverse events following SRS for NFPAs.

Main Methods:

  • Retrospective review of 178 patients with NFPAs treated with CyberKnife radiosurgery.
  • Assessment of tumor control, new-onset hypopituitarism, and new visual disorders.

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  • Analysis of progression-free survival and cumulative incidence of hypopituitarism over extended follow-up periods.

    • Main Results:

    • High tumor control rates observed, with 10-year progression-free survival at 93.04%.
    • New-onset hypopituitarism occurred in 16.9% of patients, with cumulative incidence reaching 15.25% at 10 years.
    • Higher biological effective dose (>140 Gy) and single fraction equivalent dose (>16.0 Gy) were risk factors for hypopituitarism; larger tumor volume (>2.5 mL) was associated with visual disorders.

    Conclusions:

    • Stereotactic radiosurgery is an effective and relatively safe treatment for primary and residual/recurrent NFPAs.
    • Long-term tumor control is excellent, but endocrine surveillance is crucial due to the risk of hypopituitarism.
    • Risk stratification based on radiation dose and tumor volume can help personalize treatment and manage potential adverse effects.