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Sleurs C, Fletcher P, Mallucci C, Avula S, Ajithkumar T. Neurocognitive Dysfunction After Treatment for Pediatric Brain Tumors: Subtype-Specific Findings and Proposal for Brain Network-Informed Evaluations. Neurosci Bull 2023; 39:1873-1886. [PMID: 37615933 PMCID: PMC10661593 DOI: 10.1007/s12264-023-01096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/05/2023] [Indexed: 08/25/2023] Open
Abstract
The increasing number of long-term survivors of pediatric brain tumors requires us to incorporate the most recent knowledge derived from cognitive neuroscience into their oncological treatment. As the lesion itself, as well as each treatment, can cause specific neural damage, the long-term neurocognitive outcomes are highly complex and challenging to assess. The number of neurocognitive studies in this population grows exponentially worldwide, motivating modern neuroscience to provide guidance in follow-up before, during and after treatment. In this review, we provide an overview of structural and functional brain connectomes and their role in the neuropsychological outcomes of specific brain tumor types. Based on this information, we propose a theoretical neuroscientific framework to apply appropriate neuropsychological and imaging follow-up for future clinical care and rehabilitation trials.
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Affiliation(s)
- Charlotte Sleurs
- Department of Cognitive Neuropsychology, Tilburg University, 5037 AB, Tilburg, The Netherlands.
- Department of Oncology, KU Leuven, 3000, Leuven, Belgium.
| | - Paul Fletcher
- Department of Psychiatry, University of Cambridge, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospital NHS Trust, Cambridge, CB2 0QQ, UK
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Pokhrel D, Bernard ME, Knight J, St Clair W, Fraser JF. Clinical validation of novel lightning dose optimizer for gamma knife radiosurgery of irregular-shaped arteriovenous malformations and pituitary adenomas. J Appl Clin Med Phys 2022; 23:e13669. [PMID: 35748118 PMCID: PMC9359016 DOI: 10.1002/acm2.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To demonstrate the clinical feasibility of a novel treatment planning algorithm via lightning dose optimizer (LDO) on Leksell Gamma Knife (LGK) GammaPlan with significantly faster planning times for stereotactic radiosurgery (SRS) of the complex and difficult arteriovenous malformations (AVMs) and pituitary adenomas. METHODS AND MATERIALS After completing the in-house end-to-end phantom testing and independent dose verification of the recently upgraded LDO algorithm on GammaPlan using the MD Anderson's IROC anthropomorphic SRS head phantom irradiation credentialing, 20 previously treated GK-SRS patients (10 AVM, average volume 3.61 cm3 and 10 pituitary adenomas, average volume 0.86 cm3 ) who underwent manual forward planning on GammaPlan were retrospectively replanned via LDO. These pathologies were included because of the need for adequate dose delivery with organs at risk in very close proximity. LDO finds the target curvature boundary by well-formulated linear programing objectives and inversely optimizes the GK-SRS plan by isocenter placement, optimization, and sequencing. For identical target coverage, the LDO and original manual plans were compared for target conformity, gradient index, dose to critical organs, and surrounding normal brain. Additionally, various treatment delivery parameters, including beam-on time were recorded. RESULTS For both patient cohorts, LDO provided similar target coverage with better dose conformity, tighter radiosurgical dose distribution with a lower value of gradient indices (all p < 0.001), and lower dose to critical organs. For AVMs, there was a significant reduction of normal brain V10Gy , V12Gy , and V14Gy by 4.74, 3.67, and 2.67 cm3 (all p < 0.001). LDO had twice the number of shots (p < 0.001), and longer beam-on time (p = 0.012) by a factor of 1.44. For pituitary adenomas, LDO provided systematically lower values of V10Gy , V12Gy , and V14Gy by 1.08, 0.86, and 0.68 cm3 (all p < 0.001), and lower maximum dose to optic pathway by 0.7 Gy (p = 0.005), but had almost twice the numbers of shots (p < 0.001) and increased beam-on time (p = 0.005) by a factor of 1.2. However, for both patient groups, the average planning time for the LDO was <5 min, compared to the estimated 30-90 min of manual planning times. CONCLUSION GK-SRS treatment on Leksell Perfexion GammaPlan using the LDO provided highly conformal target coverage with a steep dose gradient, spared critical organs, and significantly reduced normal brain dose for complex targets at the cost of slightly higher treatment times. LDO generated high-quality treatment plans and could significantly reduce planning time. If available, the LDO algorithm is suggested for validation and clinical use for complex and difficult GK cases.
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Affiliation(s)
- Damodar Pokhrel
- Department of Radiation Medicine, Gamma Knife Radiosurgery Center, University of Kentucky, Lexington, Kentucky, USA
| | - Mark E Bernard
- Department of Radiation Medicine, Gamma Knife Radiosurgery Center, University of Kentucky, Lexington, Kentucky, USA
| | - James Knight
- Department of Radiation Medicine, Gamma Knife Radiosurgery Center, University of Kentucky, Lexington, Kentucky, USA
| | - William St Clair
- Department of Radiation Medicine, Gamma Knife Radiosurgery Center, University of Kentucky, Lexington, Kentucky, USA
| | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
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Cao C, Huang Y, Chen A, Xu G, Song J. Improvement in Attention Processing After Surgical Treatment in Functional Pituitary Adenomas: Evidence From ERP Study. Front Neurol 2021; 12:656255. [PMID: 34659078 PMCID: PMC8517483 DOI: 10.3389/fneur.2021.656255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/28/2021] [Indexed: 01/20/2023] Open
Abstract
Cognitive abilities are impaired in patients with pituitary adenoma. However, studies on attention processing impairment in preoperative patients and attention processing recovery after transsphenoidal adenomectomy are lacking. The study aims to identify the electrophysiological change that relates to attention processing in pituitary patients before and after treatment. Twenty five preoperative pituitary patients and 25 follow-up postoperative patients were recruited. 27 healthy controls (HCs) were matched to the patients with age, gender, and education. Event-related potentials were used to investigate the attention processing in the preoperative patients, postoperative patients, and HCs. Across three groups, all emotional stimuli evoked P200 components. Compared with the HCs or postoperative patients, the amplitudes of P200 in the preoperative patients were higher. Moreover, The amplitudes of P200 decreased in the postoperative patients, which were similar to that in the HCs. The attention processing was improved after surgery, but no significant differences were detected between the postoperative patients and HCs. Abnormal hormone levels may be relevant to the factor that impair attention processing. Compared with that of the HCs and postoperative patients, the P200 component elicited by negative stimuli is higher in preoperative patients, which may illustrate compensatory activity after attention impairments. Furthermore, these data indicate that improvements in attention processing may be attributed to the amelioration of endocrine disorders. This study shows that the P200 component may be used to diagnose attention processing in preoperative pituitary patients and prove the improvement of attention processing in postoperative patients.
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Affiliation(s)
- Chenglong Cao
- Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, Netherlands
- The First School of Clinical Medical University, Southern Medical University, Guangzhou, China
| | - Yujing Huang
- Key Laboratory of Structural Biology of Zhejiang Province, Westlake University, Hangzhou, China
| | - Aobo Chen
- The First School of Clinical Medical University, Southern Medical University, Guangzhou, China
| | - Guozheng Xu
- The First School of Clinical Medical University, Southern Medical University, Guangzhou, China
| | - Jian Song
- Department of Neurosurgery, Central Theater Command General Hospital of the Chinese People's Liberation Army, Wuhan, China
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Abstract
External radiation therapy (RT) directed to the pituitary gland is generally recommended in patients with Cushing's disease (CD) as adjuvant to transsphenoidal surgery, among other second-line therapies offered to patients with residual or recurrent hypercortisolism (i.e., medical treatment, repeat surgery or bilateral adrenalectomy). RT is effective for the control of tumor growth, even in invasive tumors and in Nelson's syndrome. Progress in radiation stereotactic techniques lead to improved tumor targeting and radiation delivery, thus sparing the adjacent brain structures. Stereotactic RT is associated with a 55-65% rate of cortisol normalization after several months to a few years and potentially with a lower risk of long-term complications, compared with conventional RT. Cortisol-lowering medical therapy is recommended while awaiting the radiation effects. Hypopituitarism is the most frequent side-effect, damage to optic or cranial nerves or second brain tumors are rarely reported. This review presents the updates in the efficacy and safety of the stereotactic radiation techniques in CD patients. Practical points which should be considered by the clinician before recommending RT are also presented.
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Affiliation(s)
- Monica Livia Gheorghiu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; National Institute of Endocrinology C.I. Parhon, Bucharest, Romania.
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5
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Tooze A, Sheehan JP. Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery. J Neurosurg 2019; 129:55-62. [PMID: 30544290 DOI: 10.3171/2018.7.gks181595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.METHODSThis was a retrospective, institutional review board-approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing's disease and those with nonfunctioning adenoma (NFA).RESULTSThe entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing's disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = -3.41, p = 0.003) and delayed memory (t = -3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.CONCLUSIONSOverall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.
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Affiliation(s)
- Alana Tooze
- 1Sussex Rehabilitation Centre, Princess Royal Hospital, Haywards Heath, Sussex, United Kingdom; and
| | - Jason P Sheehan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Gao L, Xing B. Letter to the Editor. Upfront GKS for Cushing's disease and acromegaly: is it suitable? J Neurosurg 2019; 131:649-651. [PMID: 30485181 DOI: 10.3171/2018.9.jns182542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lu Gao
- 1Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 2China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Beijing, China; and
- 3Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing, China
| | - Bing Xing
- 1Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 2China Pituitary Disease Registry Center, China Pituitary Adenoma Specialist Council, Beijing, China; and
- 3Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing, China
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Pertichetti M, Serioli S, Belotti F, Mattavelli D, Schreiber A, Cappelli C, Padovani A, Gasparotti R, Nicolai P, Fontanella MM, Doglietto F. Pituitary adenomas and neuropsychological status: a systematic literature review. Neurosurg Rev 2019; 43:1065-1078. [DOI: 10.1007/s10143-019-01134-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
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Castinetti F, Brue T, Ragnarsson O. Radiotherapy as a tool for the treatment of Cushing's disease. Eur J Endocrinol 2019; 180:D9-D18. [PMID: 30970325 DOI: 10.1530/eje-19-0092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022]
Abstract
Treatment of Cushing's disease (CD) is one of the most challenging tasks in endocrinology. The first-line treatment, transsphenoidal pituitary surgery, is associated with a high failure rate and a high prevalence of recurrence. Re-operation is associated with an even higher rate of a failure and recurrence. There are three main second-line treatments for CD - pituitary radiation therapy (RT), bilateral adrenalectomy and chronic cortisol-lowering medical treatment. All these treatments have their limitations. While bilateral adrenalectomy provides permanent cure of the hypercortisolism in all patients, the unavoidable chronic adrenal insufficiency and the risk of development of Nelson syndrome are of concern. Chronic cortisol-lowering medical treatment is not efficient in all patients and side effects are often a limiting factor. RT is efficient for approximately two-thirds of all patients with CD. However, the high prevalence of pituitary insufficiency is of concern as well as potential optic nerve damage, development of cerebrovascular disease and secondary brain tumours. Thus, when it comes to decide appropriate treatment for patients with CD, who have either failed to achieve remission with pituitary surgery, or patients with recurrence, the pros and cons of all second-line treatment options must be considered.
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Affiliation(s)
- Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Marseille Medical Genetics, Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Marseille Medical Genetics, Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse, Marseille, France
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
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Lee CC, Trifiletti DM, Sahgal A, DeSalles A, Fariselli L, Hayashi M, Levivier M, Ma L, Álvarez RM, Paddick I, Regis J, Ryu S, Slotman B, Sheehan J. Stereotactic Radiosurgery for Benign (World Health Organization Grade I) Cavernous Sinus Meningiomas—International Stereotactic Radiosurgery Society (ISRS) Practice Guideline: A Systematic Review. Neurosurgery 2018; 83:1128-1142. [DOI: 10.1093/neuros/nyy009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio DeSalles
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Laura Fariselli
- Radiotherapy unit, Radiosurgery dep Istituto neurologico Carlo Besta Foundation, Milan, Italy
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- Division Physics, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Roberto Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Ian Paddick
- Division Physics, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jean Regis
- Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
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The dysfunction of inhibition control in pituitary patients: evidence from the Go/Nogo event-related potential study. Neuroreport 2018; 28:272-278. [PMID: 28225481 DOI: 10.1097/wnr.0000000000000757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pituitary tumor is an intracranial tumor; because of the development of neuroimaging technology in recent years, morbidity is likely to increase. Evidence showed impaired cognitive ability of patients with pituitary adenoma. There is evidence that neurobehavioral disorders are common in pituitary adenoma patients. This disorder is because of the cognitive and emotional function of the important functional areas of the brain oppressed and hormone imbalance. Individuals' mental activity is controlled by the brain and the abnormal mental activity is caused by both the structural abnormalities of the brain and neurochemical dysfunction. Event-related potentials have been used widely in the early assessment of cognitive functions associated with disease, taking advantage of the high temporal resolution, and then analyzing the characteristics of emotional competence from the perspective of cognitive processing. A visual Go/Nogo task was used. A larger Nogo-N2 and Nogo-P3 was found in the control group compared with the pituitary group. This reflects the nonphysiological process of conflict monitoring and inhibitory control in pituitary patients. The results also showed that the difference waves between Go and Nogo conditions (N2d and P3d) over the frontal electrode sites were more robust and earlier in the control group compared with the pituitary group, which reflects frontal dysfunction in the pituitary group. These data suggest reduced earlier and later stages of inhibitory processes in pituitary individuals, implicating the dysfunction of conflict detection and inhibitory control.
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Alibas H, Uluc K, Kahraman Koytak P, Uygur MM, Tuncer N, Tanridag T, Gogas Yavuz D. Evaluation of depressive mood and cognitive functions in patients with acromegaly under somatostatin analogue therapy. J Endocrinol Invest 2017; 40:1365-1372. [PMID: 28660605 DOI: 10.1007/s40618-017-0722-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/23/2017] [Indexed: 01/05/2023]
Abstract
AIMS Acromegaly is caused by a pituitary adenoma that releases excess growth hormone (GH) and a concomitant increase in insulin-like growth factor 1 (IGF-1). Acromegaly results not only in phenotypic changes, but also in neurologic complications as peripheral neuropathy and cognitive dysfunction. This study aimed to compare depressive mood and cognitive function in patients with acromegaly and in healthy controls as well as to determine the factors underlying cognitive dysfunction in the acromegalic patients. MATERIALS AND METHODS This study included 42 patients with acromegaly that were receiving somatostatin analogue therapy and 44 healthy controls. Memory, attention, visuospatial function, inhibitory function, abstract thinking, verbal fluency, and depressive mood were measured in the patients and controls. RESULTS Patients with acromegaly had lower learning (p = 0.01), planning (p = 0.03), complex attention and inhibitory function (p = 0.04) scores than the controls. There was no significant difference in depressive mood between the patients and controls (p > 0.05). Gamma knife radiosurgery did not negatively affect cognitive function (p > 0.05). CONCLUSION The present findings show that acromegaly negatively affects learning, attention, and planning.
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Affiliation(s)
- H Alibas
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey.
| | - K Uluc
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - P Kahraman Koytak
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - M M Uygur
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, İc hastalıklari ABD, Endokrinoloji ve Metabolizma BD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - N Tuncer
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - T Tanridag
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - D Gogas Yavuz
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, İc hastalıklari ABD, Endokrinoloji ve Metabolizma BD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
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12
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The impact of transsphenoidal surgery on neurocognitive function: A systematic review. J Clin Neurosci 2017; 42:1-6. [DOI: 10.1016/j.jocn.2017.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
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13
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The impact on cognitive functions of patients with pituitary adenoma before and after surgery. Neurol Sci 2017; 38:1315-1321. [DOI: 10.1007/s10072-017-2980-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/26/2017] [Indexed: 12/19/2022]
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Gheorghiu ML, Fleseriu M. STEREOTACTIC RADIATION THERAPY IN PITUITARY ADENOMAS, IS IT BETTER THAN CONVENTIONAL RADIATION THERAPY? ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:476-490. [PMID: 31149219 DOI: 10.4183/aeb.2017.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pituitary radiotherapy (RT) has undergone important progress in the last decades due to the development of new stereotactic techniques which provide more precise tumour targeting with less overall radiation received by the adjacent brain structures. Pituitary surgery is usually first-line therapy in most patients with nonfunctioning (NFPA) and functioning adenomas (except for prolactinomas and large growth hormone (GH) secreting adenomas), while RT is used as second or third-line therapy. The benefits of RT (tumour volume control and, in functional tumours, decreased hormonal secretion) are hampered by the long latency of the effect and the potential side effects. This review presents the updates in the efficacy and safety of the new stereotactic radiation techniques in patients with NFPA, GH-, ACTH- or PRL-secreting pituitary adenomas. Methods A systematic review was performed using PubMed and articles/abstracts and reviews detailing RT in pituitary adenomas from 2000 to 2017 were included. Results Stereotactic radiosurgery (SRS) and fractionated stereotactic RT (FSRT) provide high rates of tumour control i.e. stable or decrease in tumour size, in all types of pituitary adenomas (median 92 - 98%) at 5 years. Endocrinological remission is however significantly lower: 44-52% in acromegaly, 54-64% in Cushing's disease and around 30% in prolactinomas at 5 years. The rate of new hypopituitarism varies from 10% to 50% at 5 years in all tumour types and as expected increases with the duration of follow-up (FU). The risk for other radiation-induced complications is usually low (0-5% for new visual deficits, cranial nerves damage or brain radionecrosis and extremely low for secondary brain tumours), however longer FU is needed to determine rates of secondary tumours. Notably, in acromegaly, there may be a higher risk for stroke with FSRT. Conclusion Stereotactic radiotherapy can be an effective treatment option for patients with persistent or recurrent pituitary adenomas after unsuccessful surgery (especially if residual tumour is enlarging) and/or resistance or unavailability of medical therapy. Comparison with conventional radiation therapy (CRT) is rather difficult, due to the substantial heterogeneity of the studies. In order to evaluate the potential brain-sparing effect of the new stereotactic techniques, suggested by the current data, long-term studies evaluating secondary morbidity and mortality are needed.
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Affiliation(s)
- M L Gheorghiu
- "Carol Davila" University of Medicine and Pharmacy, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - M Fleseriu
- Oregon Health & Science University, Departments of Medicine (Endocrinology) and Neurological Surgery, and Northwest Pituitary Center, Portland, USA
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Sebastian P, Balakrishnan R, Yadav B, John S. Outcome of radiotherapy for pituitary adenomas. Rep Pract Oncol Radiother 2016; 21:466-72. [PMID: 27489518 DOI: 10.1016/j.rpor.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/06/2016] [Accepted: 06/26/2016] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this study was to analyze the outcome and toxicities and its correlation to patient related and treatment related factors. BACKGROUND Pituitary adenomas are treated by radiation therapy (RT) as one of the modalities along with surgery and medical therapy. RT to pituitary adenomas is a challenge due to adjacent dose limiting structures such as optic apparatus and hypothalamus. MATERIALS AND METHODS Between January 2004 and December 2010, 94 patients treated for pituitary adenoma with RT who had hospital records of a minimum follow-up of 1 year were included in the analysis. Tests of correlation were done with regards to treatment factors. RESULTS Male preponderance was noted in our patient population. Nonfunctioning and functioning tumors were equal in number in this series. Hypopituitarism was associated in 58.5% of patients prior to RT. Radiological tumor progression was seen in one patient (1/94) who had a nonfunctioning tumor. Among functioning tumors, biochemical remission was seen in 93.6% of patients at a median follow-up of 6 years. CONCLUSIONS Visual complication was seen in 5.3% of patients and worsening or new onset hypopituitarism was seen in 6.4%. Conventional 3-field technique was associated with significantly more visual complication compared to Stereotactic Radiation Therapy (SRT) technique. Doses ≤50.4 Gy showed a trend of reduced rate of visual and endocrine complications with no compromise in efficacy.
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Key Words
- 3DCRT, 3 dimensional conformal radiotherapy
- ACTH, adrenocorticotropic hormone
- CR, complete response
- CT, computerized tomography
- Complications
- FSH, follicle-stimulating hormone
- FSRT, fractionated stereotactic radiotherapy
- GH, growth hormone
- GTC, Gill Thomas Cosman
- Gy, Gray
- Hypopituitarism
- MRI, magnetic resonance imaging
- MV, megavoltage
- PR, partial response
- Pituitary
- RT, radiation therapy
- Radiotherapy
- SD, stable disease
- SPSS, Statistical Package for the Social Sciences
- SRS, stereotactic radiosurgery
- SRT, stereotactic radiotherapy
- Visual
- cGy, centiGray
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Affiliation(s)
- Patricia Sebastian
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | | | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Subhashini John
- Department of Radiation Oncology, Christian Medical College, Vellore, India
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Fu P, He YS, Cen YC, Huang Q, Guo KT, Zhao HY, Xiang W. Microneurosurgery and subsequent gamma knife radiosurgery for functioning pituitary macroadenomas or giant adenomas: One institution’s experience. Clin Neurol Neurosurg 2016; 145:8-13. [DOI: 10.1016/j.clineuro.2016.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/22/2016] [Accepted: 03/26/2016] [Indexed: 10/22/2022]
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Abstract
After transsphenoidal surgery, Cushing's disease (CD) shows excellent long-term remission rates, but it may recur and pose a therapeutic challenge. Findings in recent published reports on the treatment of recurrent adrenocorticotropic hormone (ACTH)-secreting tumors suggest that repeat resection, radiation-based therapies such as Gamma Knife surgery and proton-beam radiosurgery, pharmacotherapy, and bilateral adrenalectomy all have important roles in the treatment of recurrent CD. Each of these interventions has inherent risks and benefits that should be presented to the patient during counseling on retreatment options. Radiation-based therapies increasingly appear to have efficacies similar to those of repeat resection in achieving biochemical remission and tumor control. In addition, an expanding retinue of medication-based therapies, several of which are currently being evaluated in clinical trials, has shown some promise as tertiary adjunctive therapies. Lastly, bilateral adrenalectomy may offer durable control of refractory recurrent CD. An increasing number of published studies with long-term patient outcomes highlight the evolving treatment patterns in the management of recurrent CD.
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White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery. J Neurooncol 2014; 121:583-90. [PMID: 25445836 DOI: 10.1007/s11060-014-1670-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/23/2014] [Indexed: 12/21/2022]
Abstract
Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.
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Yedinak CG, Fleseriu M. Self-perception of cognitive function among patients with active acromegaly, controlled acromegaly, and non-functional pituitary adenoma: a pilot study. Endocrine 2014; 46:585-93. [PMID: 24282035 DOI: 10.1007/s12020-013-0106-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
Pituitary adenomas (PAs) represent 15 % of all brain tumors. One-sixth of these are reported to cause acromegaly via excess growth hormone secretion. These tumors have been associated with multiple comorbidities, including neuropsychiatric and cognitive dysfunction. We aimed to assess patient perception of cognitive deficits and the relationship of cognitive changes to active acromegaly (AA) versus controlled acromegaly (CA) versus non-functional PAs (NFPA). A modified FACT-Cog survey was used, which focused on the prevalence and severity of perceived dysfunction in five areas of cognitive function: ability to learn, concentration/distractibility, mental agility, memory and recall, and verbal recall. Patient perception of current health and health change over the previous 12 months was also assessed. The overall perceived prevalence and severity of cognitive dysfunction were the highest among NFPA groups, particularly in the areas of mental agility, verbal recall, and memory/recall. Patients with AA reported greater prevalence and severity of dysfunction with respect to concentration/distractibility and ability to learn. Patients with AA reported the best overall current health, though patients with CA reported the greatest improvement in health over the previous year. These findings may indicate that PAs can affect cognitive function regardless of whether excess growth hormone is present. Acromegaly and NFPA patients perceive specific areas of cognitive dysfunction that may require further evaluation and treatment. Further research may be useful regarding patient quality of life, patient functionality during normal daily activities, and perceived dysfunction despite biological disease control.
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Affiliation(s)
- Chris G Yedinak
- OHSU Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd BTE472, Portland, OR, USA,
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Sheehan J. Stereotactic radiosurgery for functioning pituitary adenomas--a higher dose is better but only up to a point. World Neurosurg 2013; 82:e75-6. [PMID: 23459276 DOI: 10.1016/j.wneu.2013.02.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/22/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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