Fractionated stereotactic radiotherapy for pituitary adenomas following microsurgical resection: safety and efficacy.

The treatment of pituitary adenomas following medical management has historically involved surgical excision or stereotactic radiosurgery, with the two modalities often utilized collectively. However, there have been only a limited number of reports on the use of fractionated stereotactic radiotherapy (FSRT) for the treatment of pituitary adenomas. To enhance the existing knowledge regarding the safety and efficacy of this treatment modality, we describe our initial experience with FSRT for residual pituitary adenomas following microsurgical resection. From 1999 to 2005, 14 patients (7F, 7M) with residual pituitary adenomas (7 nonsecretory, 2 growth hormone secreting, 2 prolactin secreting, 2 thyrotropin secreting, 1 adrenocorticotropic hormone secreting) underwent FSRT. All patients were planned using the Radionics X-Knife 3D planning system, and received a median dose of 50.4 Gy in daily 1.8 Gy fractions administered to the 90% prescription isodose line. Treatments were delivered stereotactically using a dedicated Varian 6/100 linear accelerator, with immobilization achieved with the Gill-Thomas-Cosman relocatable head frame. Mean tumor size was 3.6 cm (median, 3.2 cm), and mean patient age was 44.6 years (median, 47 years). The mean dosages to the optic chiasm and brainstem were 0.159 and 0.040 Gy (median, 0.163 and 0.031 Gy) per fraction. All patients were evaluated with visual field testing and pre- and postgadolinium-enhanced magnetic resonance imaging at a minimum of one year follow-up (median, 22.5 months; mean, 27.8 months). Following FSRT, local control (defined as absence of tumor progression) was achieved in all fourteen patients. Three patients developed hypopituitarism (average, 30 months after treatment), with no patient experiencing visual changes or acute complications following FSRT. These results demonstrate the efficacy and safety of FSRT for achieving long-term local tumor control for pituitary adenomas, further validating this technique as an appropriate treatment modality for residual adenomas following microsurgery.

Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases.

We retrospectively reviewed 35 cases of adenoid cystic carcinoma that had originated in the minor salivary glands of the paranasal sinuses or nasal cavity. All patients had been seen at two tertiary-care referral centers in western New York State between 1960 and 2000. Twenty patients had been treated with surgery and adjuvant radiotherapy, 10 patients with surgery alone, three with radiotherapy alone, and two with concurrent radiotherapy and chemotherapy. During the study, 22 patients developed recurrent disease--11 locally; three distantly; seven locally and distantly; and one locally, regionally, and distantly. At the conclusion of the study, 14 patients were alive and disease-free, and eight were alive with disease; 10 patients had died with disease, and three had died of other causes with no evidence of disease. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity is an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis, regardless of treatment modality. Most cases are ultimately fatal, although long disease-free intervals have been observed. A combination of surgery and radiotherapy offers these patients the best chance for disease control.

Safety and efficacy of fractionated stereotactic radiotherapy for acoustic neuromas.

BACKGROUND: The treatment of acoustic neuromas (AN) has historically involved surgical excision or stereotactic radiosurgery, with a relatively limited number of reports available describing the use of fractionated stereotactic radiotherapy (FSRT). To enhance the existing knowledge regarding the safety and efficacy of this treatment modality, we describe our initial experience with FSRT for AN. METHODS: From 1999-2005, 20 patients (12F, 8M) with AN underwent FSRT. All patients were treated using the Radionics X-Knife 4.0 3D planning system, receiving 54 Gy in 1.8 Gy daily fractions with a prescription isodose line of 90%. Treatments were delivered stereotactically using a dedicated Varian 6/100 linear accelerator, with immobilization achieved via the Gill-Thomas-Cosman relocatable frame. Median tumor size (maximum diameter) was 2.1 cm (range, 1.1-3.4 cm). Median patient age was 49.5 years, with median follow-up of 22 months (range, 1-66 months). All patients were evaluated with pre- and post-gadolinium-enhanced magnetic resonance imaging. RESULTS: Following FSRT, local tumor control was achieved in every patient, with the treatment well-tolerated by all patients. No patient experienced acute complications or facial nerve weakness. Two patients experienced permanent trigeminal nerve morbidity manifesting as facial numbness. All nine patients with preserved hearing before treatment had hearing preservation at last follow-up, although four of these patients experienced hearing decline following FSRT. CONCLUSION: In our series of 20 patients with AN, all had local tumor control following FSRT, with minimal morbidity. These results support the growing body of literature demonstrating the safety and efficacy of FSRT in achieving local control for AN, further validating the viability of FSRT as a treatment modality for this patient population.