Evaluate tumor size control according to the RECIST
standard
After follow-up, we noted that the pituitary adenoma fully
responded to Gamma knife radiosurgery accounted for 13.6%,
partially response accounted for 50.6%, stable disease accounted for
33.3% and had 2.5 % of tumor progression increased in size.
Nguyen Thi Minh Phuong noted the tumor response with
Gamma knife radiosurgery according to the RECIST standard in 44
pituitary adenomas showed that: complete response accounted for
6.3%, partial response accounted for 41.7%, stable disease accounted
for the highest rate of 43.8%, progressive disease met 8.3%. In the
treatment of 30 pituitary adenomas, Sallabanda K. showed that 63%
of patients had tumors that did not change in size after Gamma knife
radiosurgery, 30% of tumors decreased in size and 7% of tumors
increased in size after radiosurgery
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adenomas after surgery.
Research has shown the effectiveness of radiosurgery in the
treatment of recurrent or residual pituitary adenomas. The control of
tumor size by radiosurgery achieved a very good result of 98%.
Additionally, most residual or recurrent pituitary adenomas with
increased hormone secreted have hormone levels returning to normal.
The response time for hormones to return to normal is from 6 months
after Gamma knife radiosurgery.
Dissertation layout:
3
The thesis consists of 137 pages: Introduction (2 pages),
Overview (39 pages), Objects and research methods (25 pages),
Results (31 pages), Discussion (37 pages), Conclusion (2 pages), and
Proposals (1 page).
In this thesis, there are 35 tables, 25 charts, 10 pictures and 1
appendix. There are 138 references, including 10 Vietnamese and
128 English.
CHAPTER 1: OVERVIEW
1.1. Gamma knife radiosurgery in residual or recurrent pituitary
adenomas after surgery
1.1.1. Natural progression of pituitary adenomas after surgery
The pituitary adenoma recurrence rate is often high, 12.8-42% of
cases. There are many studies evaluating how the natural progression
of residual pituitary adenomas after surgery will develop over time.
Tanaka Y. et al assessed 40 cases of residual pituitary adenoma
patients after surgery for the time the pituitary adenoma volume
doubled, and the author found that the time of doubled volume were
average 1836 days, varying from 506 to 5378 days. Honergger J. et al
published in the European Endocrinology Journal followed up 15
cases of residual pituitary adenoma patients for a period of 7.4 years,
the author found that the doubled volume presented after 3.1 years,
varies from 0.8 to 27.2 years. Ekramullah S.M. et al reported that the
time of pituitary adenoma volume doubled when studying 14 patients
with non-functional pituitary adenomas as 930 days, varying from
200 to 2550 days.
4
Table 1.2. The time of doubled volume in residual pituitary
adenomas after surgery
Author Year
Number of
patients
Time of
follow up
Time of
doubled volume
Tanaka Y. 2003 40
52.5
months
1836 days
Honergger J. 2008 15 7.4 years 3.1 years
Ekramullah S.M. 1996 14 5 years 930 days
1.1.2. Research situation in Vietnam and the world
In 2007, Jagannathan J. et al studied in the US on 90 patients
with pituitary adenomas treated with the rotary Gamma knife, an
average radiation dose of 23 Gy, and the follow-up time for an
average of 45 months, the author found that 80% of patients have
reduced the tumor size.
Tanaka S. et al studied the treatment of 22 patients who had PRL
secreting pituitary adenomas after surgery with the rotary Gamma
knife, an average radiation dose of 25 Gy and the patient was
monitored for 60 months. The results showed that tumor control
reached 100%.
Yazdani O.S. et al evaluated over 100 patients with pituitary
adenomas treated with Gamma knife radiosurgery. There were 46
patients with non-fuctional pituitary adenomas and 54 patients with
functional pituitary adenomas. After the radiosurgery, the effective
control of the tumor size is 92% (the reduced size by 28%,
unchanged by 64%). The response rate for tumor size with GH
secreting tumors is 73%, returning normal hormone levels is 48%,
with PRL secreting tumors is 67%, returning normal hormone levels
5
is 46%, with ACTH secreting tumors is 70%, returning normal
hormone levels is 35%.
According to Nguyen Thi Minh Phuong et al researched on 73
patients of pituitary adenomas, including 48 patients treated with
radiosurgery at the Center for Nuclear Medicine and Oncology Bach
Mai Hospital: symptoms clinically decreased over time, the size of
the pituitary adenoma decreased significantly after 12, 24 and 36
months. Response to tumor size after radiosurgery: complete (6.3%),
partial (41.7%), stable disease (43.8%), progressive disease (8.3%).
Hormonal response: returning nornal levels after 6, 12, 24 and 36
months, the incidence increased gradually in the hormone secreting
tumor group. Hypopituitarism after intervention were low with
12.5%, other complications were mild and transient.
CHAPTER 2: OBJECTS AND METHODS
2.1. Research obbjects
The study had 81 patients who had residual or recurrent pituitary
adenomas after surgery. The patient was examined, treated and
monitored at Gamma Knife Unit - Department of Neurosurgery, Cho
Ray Hospital from January 2012 to March 2017.
2.1.1. Selecting Criterias
- Patients who had performed surgery for pituitary adenoma. The
patient had residual or recurrent tumors after surgery with the largest
diameter of the tumor < 4 cm detected by MRI. Gamma knife
radiosurgery is indicated to prevent the development of pituitary
tumors.
- Patients with adequate tests of pituitary hormones.
6
- The general condition is still good: Karnofsky index> 70, not
suffering from acute and serious diseases.
- The patient is indicated for adjuvant treatment by radiosurgery
with Leksell Gamma Knife radiosurgery system at Gamma Knife
Unit - Neurosurgery Department, Cho Ray Hospital.
- The patient agreed to participate in the study.
- Have completed archive records.
2.1.2. Exclusion criterias
- The patient had performed Gamma kinife radiosurgery
previously.
- The general condition is poor, has consciousness disorder or
severe intracranial pressure condition.
- Patients with other cancers.
- Women who are pregnant or breastfeeding.
- Patients using drugs that affect the results of functional tests of
the pituitary gland such as psychotropic drugs, glucocorticosteroids,
levothyroxine, rifampicine, ketoconazole.
2.2. Research Methods
2.2.1. Research design
The retrospective study combined with prospective, cross-over
follow-up.
2.2.2. Research location
The project was conducted at Gamma Knife Unit - Neurosurgery
Department of Cho Ray Hospital.
2.2.3. Research time
From January 2012 to March 2017.
7
2.2.4. Sample size
We apply the formula for calculating the sample size:
2
2
)2/1( )1(
d
ppZ
n
(2.1)
- p: tumor control rate of Gamma knife radiosurgery in previous
studies. We aim to a 95% efficiency so we chose p=0.95.
Applying the formula for calculating the sample size (formula
2.1), we calculated the theoretical sample size of 73 patients. The
expected rate of sample loss is 10%, so the sample size is 80 patients.
The study recruited 81 patients.
Following the guidance of RTOG 90-05 (Radiation therapy
oncology group) the radiation dose according to the size and volume
of the tumor is as below:
Table 2.1. Radiation dose according to the diameter and volume
tumor
Average diameter
(mm)
Volume tumor
(cm
3
)
Max dose
(Gy)
12.5 1.02 27.5
15.0 1.77 25.0
17.5 2.81 22.5
20.0 4.19 20.0
22.5 5.96 18.7
25.0 8.18 17.5
27.5 10.9 16.5
30.0 14.1 15.0
32.5 18.0 14.0
(Flickingera J.C., et al, 2013)
8
Table 2.2. Radiation dose according to the type of tumor
Type Average dose (Gy) Range dose (Gy)
Non-functional PA 15.8 8-22.5
GH-secreting PA 19.4 12-25
ACTH-secreting PA 20.7 15-29.5
PRL-secreting PA 18.7 13.3-33
Other secreting PA 12-28.7
(Flickingera J.C., et al, 2013)
Table 2.3. Response to treatment according to the RECIST standard
Excellent Totally lesion disappeared.
Good
The total diameter of the tumors decreased by at least
30% compared to the total diameter of tumors
measured before treatment.
Worse
The sum of the tumor diameters increased by at least
20% compared to the sum of the original tumor
diameters or the sum of the smallest tumor diameters
in the study.
Stable
The total diameters are neither smaller nor smaller
but are not sufficient to be considered partial or large
enough to be considered progressive compared to the
smallest total diameter during the study period.
(Eisenhauera P., et al, 2009)
9
Table 2.4. Response of hormone levels
Normal Hormone levels within normal limits.
Response
Hormone levels have not returned to normal
limits but decreased by over 50% compared to
before treatment.
Stable
Hormones remain unchanged from before
treatment or reduce by 50% compared to
before treatment.
Progressive
Hormone levels continue to increase
compared to before treatment.
(Castro D.G., et al, 2010)
CHAPTER 3: RESULTS
3.1. General characteristics
Table 3.1. Distribution of patients by age groups
Tumor
Age
Functional PA
Non-functional
PA
Total
n % n % n %
< 40 11 47.8 19 32.8 30 37.0
40 – 49 7 30.4 18 31.0 25 30.9
≥ 50 5 21.8 21 36.2 26 32.1
Total 23 100 58 100 81 100
Average age
(min-max)
39.48 ± 12.12
(18-65)
44.88 ± 11.67
(23-73)
43.35 ± 11.98
(18-73)
10
Table 3.2. Gender
Tumor
Gender
Functional PA
Non-functional
PA
Total
n % n % n %
Male 11 47.8 27 46.6 38 46.9
Female 12 52.2 31 53.4 43 53.1
Total 23 100 58 100 81 100
3.2. Clinical characteristics
Table 3.3. Clinical symptoms
Synptoms
Patients (n=81)
Number (N) %
Compressing
syndrome
Memory loss 13 16
Headache 68 84
Visual disturbances 44 54.3
Paralysis III 4 4.9
Paralysis IV 4 4.9
Visual field defect 42 51.9
Endocrine
Syndrome
Lactation 6 13.9
Hypopituitarism 25 30.9
Menstrual disorders 8 18.6
Erectile dysfunction 11 13.6
Acromegaly 14 17.3
11
3.3. Results of radiosurgery
81 patients undergoing radiosurgery (radiation group) had to be
followed 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after
treatment.
3.3.1 General characteristics
Table 3.4. Radiation dose
Radiation
dose (Gy)
Functional
PA
(n=23)
Non-
functional
PA (n=58)
Total
(n=81)
p value
Average 17.74 ± 2.28 15.55 ± 2.07 16.17 ± 2.33
<0.001 Min 13 12 12
Max 22 22 22
≤ 14 Gy 1 (4.3) 20 (34.5) 21 (25.9)
0.005
> 14 Gy 22 (95.7) 38 (65.5) 60 (74.1)
Chart 3.1. Clinical characteristics in functional PA (n=23)
4.3
78.3
73.9
52.2
13
0 0 0 0 0 0 0
30.4 30.4
21.7
8.7 8.7 8.7 8.7 9.5
15.4
12.5
0
10
20
30
40
50
60
70
80
90
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
Memory loss Headache Visual disturbances
12
Chart 3.2. Clinical characteristics in non-functional PA (n=58)
Chart 3.3. Response of tumor size according to the RECIST standard
In this study, 2 patients increased tumor size after the follow-up
time, so the rate of tumor control was 79/81 = 97.5%.
0
20
40
60
80
100
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
Memory loss Headache Visual disturbances
13.6
50.6
2.5
33.3
0
10
20
30
40
50
60
Totally Partial Progress Stable
13
3.3.2. Response of hormone levels
3.3.2.1. Response of PRL, GH levels
Chart 3.4. Average PRL, GH levels in functional PA (n= 23)
Chart 3.5. Rate of the new hypopituitarism after radiosurgery
121.8
105.72
89.57
75.23
59.82
48.57
38.48 36.79 38.14 41.32
17.24
22.56 19.25 16.62 14.16 11.11 9.24 6.79 5.55 4.6 3.65 3.02
0
20
40
60
80
100
120
140
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10
PRL (ng/ml) GH (ng/ml)
0
10
20
30
40
50
60
T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11
14
3.3.4. Rate of complications
Table 3.5: Rate of complications
Complications
Functional
PA
(n=23)
Non-
functional
PA
(n=58)
All
(n=81)
p
value
Overal
complications
Yes 16 (69.9) 38 (65.5) 54 (66.7)
0.727
No 7 (30.4) 20 (34.5) 27 (33.3)
Headache
Yes 5 (21.7) 12 (20.7) 17 (21.0)
0.917
No 18 (78.3) 46 (79.3) 64 (79.0)
Nausea
Yes 5 (21.7) 10 (17.2) 15 (18.5)
0.638
No 18 (78.3) 48 (82.8) 66 (81.5)
Anorexia
Yes 6 (26.1) 16 (27.6) 22 (27.2)
0.891
No 17 (73.9) 42 (72.4) 59 (72.8)
Dry mouth
Yes 8 (34.8) 18 (31.0) 26 (32.1)
0.745
No 15 (65.2) 40 (69.0) 55 (67.9)
Insomnia
Yes 4 (17.4) 15 (25.9) 19 (23.5)
0.417
No 19 (82.6) 43 (74.1) 62 (76.5)
Alopecia
Yes 7 (30.4) 6 (10.3) 13 (16.0)
0.026
No 16 (69.6) 52 (89.7) 68 (84.0)
15
CHAPTER 4: DISCUSSION
4.1. General characteristics
4.1.1. Gender
Several epidemiological studies show that in the pituitary
adenomas, the ratio of male to female depends on the different types
of tumors, generally more in women than men. A study of 219
pituitary adenomas on sex and other factors showed that the numbers
of women with small pituitary and prolactin-free tumors was higher
than in men. When studying recurrent or residual pituitary adenomas
after surgery, we found that the male to female ratio was 1: 1, of
which females accounted for 53.1%. When analyzing the function of
pituitary adenomas, we found that there was no statistically
significant difference between the male and female ratio. Our results
are similar to other authors in the world.
Chen Y.H. et al reported 22 recurrent or residual pituitary
adenomas after Gamma knife radiosurgery in Taiwan showed that the
ratio of male to female was 2: 1. However, Bir S.C. et al. studied 57
without increased hormone secreting pituitary adenomas treated with
Gamma knife radiosurgery, of which 53 patients were recurrent or
residual tumors after surgery showed the ratio male: female is equal
(56.1% and 43.9%). Sheehan J.P. reported a multicenter report that
the non-functional pituitary adenomas were treated with Gamma
knife radiosurgery in the US, in which 93.6% of pituitary adenomas
had at least a surgical removal or biopsy, showing that the percentage
of men is 55.9% and women are 44.1%, equivalently.
Thus, in terms of gender distribution, we found that the
proportion of men and women is equal
16
4.2 Evaluate the results of Gamma knife radiosurgery in
pituitary adenomas
4.2.1. Result of tumor size control
4.2.1.1. Evaluate tumor size control according to the RECIST
standard
After follow-up, we noted that the pituitary adenoma fully
responded to Gamma knife radiosurgery accounted for 13.6%,
partially response accounted for 50.6%, stable disease accounted for
33.3% and had 2.5 % of tumor progression increased in size.
Nguyen Thi Minh Phuong noted the tumor response with
Gamma knife radiosurgery according to the RECIST standard in 44
pituitary adenomas showed that: complete response accounted for
6.3%, partial response accounted for 41.7%, stable disease accounted
for the highest rate of 43.8%, progressive disease met 8.3%. In the
treatment of 30 pituitary adenomas, Sallabanda K. showed that 63%
of patients had tumors that did not change in size after Gamma knife
radiosurgery, 30% of tumors decreased in size and 7% of tumors
increased in size after radiosurgery.
Through results of the above studies, we found that the effect of
Gamma knife radiosurgery was positive, the ability to reduce the size
of the tumor and keep disease stable high, only less than 10% of
patients have progressed after Gamma knife radiosurgery.
17
4.2.1.2. Evaluation of tumor size control by Gamma knife
radiosurgery
Table 4.1. Proportion of tumor size control
Authors
Number of
patients
Radiation dose
Time of
follow-up
Rate of tumor
size control
Chen
Y.H. et al
(2013)
22 patient of
recurrent or
residual PA
25 Gy
58.1
months
100%
Grant
R.A. et al
(2014)
31 cases of
functional PA:
15 ACTH, 13
GH, 2 PRL,
1 TSH
35 Gy
40.2
months
100%
Sheehan
J.P. et al
(2013)
512 cases of
non-functional
PA
16 Gy
(5-35 Gy)
36
months
3 years: 98%;
5 years: 95%;
8 years: 91%;
10 years: 85%.
Elshirbiny
M.F. et al
(2015)
40 cases of
functional PA:
16 PRL, 16
GH, 8 ACTH
PRL: 18-22 Gy
GH: 20-25 Gy
ACTH: 25-30
Gy
20
months
(12-60
months)
PRL: 100%
GH: 87%
ACTH: 100%
Hafez
R.F. et al
(2014)
54 cases of
functional PA
PRL: 18-22 Gy
GH: 20-25 Gy
ACTH: 25-30
Gy
28
months
(12 – 84
months)
PRL: 96%
GH: 90%
ACTH: 100%
Yazdani
S.O. et al
(2015)
100 patients: 46
cases of non-
functional PA,
54 cases of
functional PA
non- functional
PA: 18 Gy
functional PA:
24 Gy
24
months
Overall: 92%
non-functional
PA: 93%.
PRL: 80%
GH: 96%
ACTH: 84%
18
We noted that the overall control rate of tumor size in the study
was 97.5%. In general, the effectiveness of controlling is higher than
90% and has the time long in controlling tumor size after Gamma
knife radiosurgery.
4.2.2. Evaluate the outcome of hormone levels
4.2.2.1. The endocrine response of functional pituitary adenomas
Table 4.2. Comparison of treatment results for functional pituitary
adenomas
Authors
Number of
patients
Radiation dose
Time of
follow up
Results
Our study 23 cases 17.74 ± 2.28 Gy 60 months
Returning normal
endocrine levels
PLR: 20%
GH: 46.7%
Nguyễn
Thị Minh
Phương
(2018)
21 cases 14.05 ± 2.89 Gy 36 months
40% cases return
normal endocrine
levels
Elshibiny
M.F. et al
(2015)
40 cases
PRL-secreting PA:
18-22 Gy
GH-secreting PA:
20-25 Gy
ACTH-secreting
PA: 25-30 Gy
20 months
(12-60
months)
Hormonal control:
PRL 56%, GH:
62%, ACTH: 62%
Yazdani
S.O. et al
(2015)
56 cases 24 Gy 24 months
Returning normal
endocrine levels
/ Good control:
GH: 48% / 73%
PLR: 46% / 67%
ACTH: 35% / 70%
19
Authors
Number of
patients
Radiation dose
Time of
follow up
Results
Iwai Y. et
al
(2009)
26
GH-
secreting
PA
20 Gy
(14-30 Gy)
84 months
(36-144
months)
Returning normal
endocrine levels
: 42%
Good control: 50%
Raef H.F.
et al
(2014)
54 cases
PRL-secreting PA:
18-22 Gy
GH-secreting PA:
20-25 Gy
ACTH-secreting
PA: 25-30 Gy
12 – 84
months
Returning normal
endocrine levels:
PRL: 62%
GH: 60%
ACTH: 70%
4.2.2.2. The time of hormonal response
When analyzing the response time to PRL and GH hormones, we
found that the time for PRL to start responding to treatment was at
the 6
th
month and the 12
th
month for GH. The time when the hormone
responds to treatment returns to normal for PRL is 18 months, GH is
30 months after Gamma knife radiosurgery. Nguyen Thi Minh
Phuong noted that the time when hormones returned to normal was
the 6
th
month after Gamma knife radiosurgery. Sallabanda et al
analyzed 30 pituitary adenomas including 26 functional pituitary
adenomas, showing 65.4% of cases returned to normal and 15.3% of
cases had an improvement in concentration levels of blood, the time
of hormonal response to normal or improved with an average of 12.3
months for GH and 61.8 months for ACTH.
Grant R.A. et al. reported that 31 patients of functional pituitary
adenomas receiving Gamma knife radiosurgery with an average
follow-up time of 40.2 months found that 70% of the patients had an
endocrine levels returning normal after the average 17.7 months’
follow-up period. The author showed that the average time of
20
hormonal levels returning normal: ACTH is 11.7 months, GH is 18.4
months and PRL is 57 months.
Thus, the response of endocrine to Gamma knife radiosurgery
returned to normal levels in our study similar to other authors in the
world. The endocrine response is usually slow starting at the 6
th
and
12
th
months after treatmenr. More than half of all cases will have a
complete endocrine response to Gamma knife radiosurgery after
follow-up. Patients with functional pituitary tumors after
radiosurgery should be treated with the adjuvant endocrine drugs to
quickly improve the endocrine concentration of blood and improve
clinical symptoms due to the increase of hormone levels.
4.2.2.3. Hypopituitarism
Hypopituitarism is a symptom that needs attention during the
radiosurgery of pituitary by Gamma knife. Besides radiation, medical
treatment also contributes significantly to the outcome of treatment.
Before Gamma knife radiosurgery, the rate of hypopituitarism in our
study was 53.1%. After Gamma knife radiosurgery, the rate of
hypopituitarism decreases gradually in the 3
rd
months and by the 6
th
month is 30.9%. However, these cases of hypopituitarism are
adjuvant treated with hormonal drugs (except in the case of impaired
GH function and sex hormones). This rate remained stable until the
end of the 36
th
month follow-up visit, after that from the 36
th
month,
the rate of hypopituitarism increased gradually until the 48
th
month at
67.6% and the 54
th
month at 54.2%. This can be explained when the
tumor responds to Gamma knife radiosurgery help reduce the size of
the tumor, thereby reducing the compression of the anterior pituitary
gland, reducing the rate of hypopituitarism. Additionaly, because of
hormonal drug supplements helped to reduce this rate.
21
However, in the latter stage, pituitary cells degenerated by
Gamma knife radiosyrgery will increase the rate of hypopituitarism.
This is also an important late complication of pituitary Gamma knife
radiosurgery. We noted that the time of new hypopituitarism after
radiosurgery occurred was the 24
th
month after treatment. It is noted
that the proportion of hypopituitarism that appears after radiosurgery
increases and stabilizes at about 32-35% after 42 months of
treatment.
Tanaka S. et al studied 22 PRL-secreting patients who had
received Gamma knife radiosurgery, average dose of 22 Gy (16-30
Gy), median follow-up time was 60 months (16-129 months) found
that 100% of the patients had decreased PRL level, the average level
from 88.4 ng/ml to an average of 28.4 ng/ml. The difference was
statistically significant with p=0.001. However, after the follow-up
period, the author noticed that 8 patients appeared a new
hypopituitarism. The average time of occurrence of new
hypopituitarism is 19 months (4-40 months). The rate of
hypopituitarism after 2 years is 23% and after 4 years is 42%.
Castinetti F. et al. reported on 76 patients with different types of
pituitary adenomas, with a minimum follow-up of 5 years and a third
of patients was followed for more than 10 years, the author found
that 21% patients develop a new hypopituitarism during an average
of 48 months, which again reinforces the importance of long-term
monitoring of hypopituitarism. The sensitivity of the hormonal axes
varies among patients, except for GH, which is always the most
sensitive to the timing of deficiency.
Zibar T.L. et al. reported 27 pituitary adenomas receiving
Gamma knife radiosurgery, the average tumor volume was 4.73 cm3,
the average radiation dose was 20 Gy, the average follow-up time
22
was 72 months showed 30% patients appear with new
hypopituitarism after Gamma knife radiosurgery, the cumulative
chart shows that the frequency of new hypopituitarism after Gamma
knife radiosurgery is 42% and the average time of occurrence of new
hypopituitarism is 41.5 months (3 -96 months).
Sheehan J.P. reported that 512 non-functional pituitary adenoma
patients undergo Gamma knife radiosurgery showed that the rate of
hypopituitarism before treatment was 58%. After the 120-month
follow-up period, the author reported a new incidence of
hypopituitarism was 21.1%. The author conducted a univariate and
multivariate analysis of risk factors for new or worsening pituitary
dysfunction including: increased radiation dose Gamma knife
radiosurgery at the edge of the tumor (OR = 1.07 [95% CI 1.01 -
1,12], p = 0,018) and previous history of Gamma knife radiosurgery
(OR = 2.44 [95% CI 1.04-5.77], p = 0.041). Patients with new visual
disorders are also more likely to have new pituitary dysfunction after
treatment (OR = 2.39 [95% CI 1.19-4.83], p = 0.015)
4.2.3. Radiosurgery complications
Our study did not record any visual complications. According to
the study of Sebastian P. et al on 94 patients in radiosurgery, visual
complications after treatment had the rate of 5.3%. Multivariate
analysis showed that the risk factors for visual complications after
Gamma knife radiosurgery is conformal Gamma knife radiosurgery
(OR = 10.36, p = 0.04). Gopalan R. noted that the visual
complication after Gamma knife radiorurgery is 6.2% (3/48 patients),
of which 2 patients had visual disturbances before surgery, 2 out of 3
patients had advanced tumors after Gamma knife radiosurgery.
23
CONCLUSION
During the study period from January 2012 to March 2017, we
collected a total of 81 cases of residual or recurrent pituitary
adenomas after surgery. We divided two types of patients:
- Functional pituitary adenomas: 23 patients (28.4%)
- Non-functional pituitary adenomas: 58 patients (71.6%)
1. Clinical and subclinical characteristics of pituitary adenoma
- The average age is 43.35 ± 11.9, the youngest is 18-year-old
and the largest is 73-year-old.
- The rat
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