Pituitary adenomas: the effect of gamma knife radiosurgery on tumor growth and endocrinopathies

Seventy-three patients have been treated with Gamma Knife radiosurgery (GKR) for pituitary adenomas. 12 had undergone surgery prior to GKR. Three had had previous radiation therapy. The prescription dose administered to the tumor margin ranged from 9 to 35 Gy. 65 patients were followed up for an average of 29 months. A slight expansion of tumor volume occurred in 3 cases. Otherwise, the tumor volume remained unchanged or decreased in the remainder. Endocrine changes were present in all except 3 cases. GKR was followed by a speedy decrease in raised serum hormone levels in the case of both growth hormone (GH)and adrenocortico-tropic hormone (ACTH). In 3 patients there was some visual deterioration associated with a slight increase in tumor volume. In 2 cases, the tumors were removed surgically. Some preliminary conclusions may be drawn. The dose required to correct an endocrinopathy may be higher than that required for control of tumor growth. The recommended prescription dose for endocrine-active adenomas may be more than 30 Gy. While clinical improvement may be noted in patients with raised serum prolactin levels (PRL), normalization of the endocrinopathy may be less readily achieved than in the case of raised GH and ACTH levels. Gamma Knife radiosurgery as a primary treatment of pituitary adenomas can be safe and effective.