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Endocrinological evaluation of the efficacy of gamma knife radiosurgery for remnant tumor in cavernous sinus after trasnssphenoidal resection of growth hormone secreting pituitary macroadenoma

Title
Endocrinological evaluation of the efficacy of gamma knife radiosurgery for remnant tumor in cavernous sinus after trasnssphenoidal resection of growth hormone secreting pituitary macroadenoma
Other Titles
성장호르몬 분비 뇌하수체 거대선종 환자에서 경접형골경유 뇌하수체 종양제거술 이후 해면정맥동내 잔존하는 종양에 대한 감마나이프 방사선수술후의 내분비학적 변화에 대한 고찰
Issue Date
2012
Publisher
Graduate School, Yonsei University
Description
Dept. of Medicine/석사
Abstract
OBJECTIVE: To determine long-term effect of gamma knife radiosurgery (GKS) for the treatment of remnant tumor in the cavernous sinus (CS) after transsphenoidal surgery (TSS) of growth hormone (GH)-secreting pituitary macroadenoma.METHODS: Seventeen patients who failed to achieve biochemical remission after TSS were followed for a mean period of 70.2 months (range 17-180) after GKS. All patients underwent regular hormonal examination including serum GH, IGF-1, oral glucose tolerance test, and combined pituitary function test(CPFT). Magnetic resonance imaging was performed 1-year after GKS and then subsequent 1.5-year interval. All patient had remnant tumor only in the CS and received hormone-suppressive medication, sandostatin LAR before or after GKS.RESULTS: There were 13 women and 4 men with a mean age of 41.8 years (range 27-62). 10 patients (58.8%) achieved hormonal remission with a mean time of 47 month (median 40, range 18-129) after GKS and mean marginal radiation dose was 27.9 Gy (range 14-35). Mean tumor volume decreased from 5.15ml (pre-GKS) to 3.55ml (last follow-up) (P <0.001). Actuarial rate of remission at 2,4, and 6 years were 12.5 %, 40%, and 64%, respectively. Intergroup comparison between remission and non-remission group those who had a minimum hormonal follow-up period of 48 months, showed both ‘serum level of GH’ and ‘degree of decreased GH percentile’ at 12 months after GKS showed significant difference (P=0.023), (P=0.014), respectively. A new pituitary hormone deficiency that has significant difference was found only in gonadal axis (P = 0.032) based on last follow-up CPFT. A radiation necrosis was detected in 4 patients.CONCLUSION: GKS in remnant tumor only in the CS after maximal resection of tumor in sellar and suprasellar area is effective especially for minimizing newly developed post-GKS hypopituitarism. However care should be done about radiation induced adjacent parenchymal necrosis after GKS in the CS especially.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/134282
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
Yonsei Authors
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