Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer
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Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer Carolina Benjamin1 · Kimberly Ashayeri2 · John G. Golfinos2 · Dimitris G. Placantonakis2 · Joshua Silverman3 · Douglas Kondziolka2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Metastases should be considered in a patient with a cancer history and a sellar/suprasellar lesion, as this diagnosis can change the management strategy in such patients. Once the diagnosis is established, stereotactic radiosurgery (SRS) can be a safe and effective approach for these patients. Methods This case series describes five patients with pituitary metastases managed with GKRS at a single institution, taken from our prospective registry. All patients had SRS using the Gamma Knife Perfexion or Icon (Elekta), according to our standard institutional protocol. The optic nerves and chiasm were contoured, and the plan was adjusted to restrict dose to the optic apparatus as necessary. The tumor margin doses delivered were 11 Gy, 12 Gy, 14 Gy, 18 Gy (3 sessions of 6 Gy), and 12 Gy at the 50% isodose line. Results In this series, all sellar metastases were treated successfully with good radiographic and clinical response. The histology of the tumors included endometrial, gastrointestinal, and lung adenocarcinomas. Typically, histology is taken into consideration when choosing the treatment dose, along with size and location. In these patients, however, the dose used for the sellar metastases was chosen primarily for visual safety. This was typically lower than the dose for brain metastases in other locations. Conclusion SRS provides an alternative treatment approach for sellar/suprasellar metastases with excellent local control, symptom improvement and maintenance of systemic therapy as desired. As such, CNS failure is rarely the proximate cause of demise in pituitary metastases provided that endocrinopathies are recognized and managed appropriately. Keywords Pituitary adenoma · Endoscopic endonasal approach · Transsphenoidal approach · Sellar metastases · Metastatic cancer · Gamma knife radiosurgery · Stereotactic radiosurgery
Introduction
Douglas Kondziolka is a senior author. * Carolina Benjamin [email protected] Douglas Kondziolka [email protected] 1
Department of Neurosurgery, University of Miami, Lois Pope Life Center, 1095 NE 14th Sreet 2nd Floor, Miami, FL 33136, USA
2
Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
3
Department of Radiation Oncology, NYU Langone Medical Center, New York, NY, USA
Pituitary metastases are rare, accounting for only 0.4% of all intracranial metastases and 1% of pituitary gland lesions [1–3]. The most common pituitary metastases are breast, non-small cell lung, renal cell, thyroid, and hepatocellular carcinoma 7. They can be difficult to distinguish radiographically from pituitary adenomas. The differentiation between a pituitary metastasis and a pituitary adenoma is significant, because patients w
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