Seri Kesehatan (Health Series); Vol 8, No 1 (2004): Juni 01/2010;
Source: OAI

ABSTRACT The Role of Irradiation in Hypophyseal Adenoma. Pituitary adenomas are histopathologically benign, however theclinical presentations are often quite severe. These clinical signs are due to the tumor mass effect, hormonaldisturbances or both. Besides that, these tumors often recurred after treatment. The treatment of pituitary tumors havedeveloped greatly with the improvement of techniques of several modalities such as surgery, radiation and medication.Multimodality treatment is often used for optimal results in treating these tumors. Radiotherapy is a cytotoxic agentusing ion radiation for the treatment of pituitary tumors in combination with other methods. Post-surgical radiotherapyhas shown to decrease the recurrence rate significantly (22-71% vs 8-23%). At present there has been rapidimprovements in radiation techniques for pituitary tumors. These developments are not only based upon the increase ofknow-how in computer technology and radiation instruments, but are also based upon the development of cellular andmolecular biology in connection with normal and tumor tissues. The objective in developing radiation methods andtechniques is to create a high radiation dose, homogeneous in the target area with low radiation dose in normal tissue.The development in science and technology, in particular concerning computer science, have created the developmentof radiation techniques and methods. This paper elaborates on several aspects of radiation in the treatment of pituitaryKeywords: pituitary adenoma, radiation, ionizing beam, recurrence

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Available from: Renindra Ananda Aman, Jul 21, 2014
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    ABSTRACT: Thirty-seven of 317 patients with pituitary adenoma who underwent transsphenoidal operation from 1989 to 1996 received adjuvant gamma knife radiosurgery. Gamma knife surgery was performed mainly in patients with endocrinologically inactive tumor for tumor regrowth invading the cavernous sinus, and in patients with endocrinologically active tumor for incomplete removal invading the cavernous sinus. The maximum radiation dose was 25–60 Gy. The periphery of the tumor usually received 50% of the maximum dose. Thirteen patients were followed up for longer than 2 years (mean 45 months) after combined therapy. Magnetic resonance imaging (MRI) showed changes in signal intensity on both T1- and T2-weighted images as early as 3 months after radiotherapy. Serial MRI showed all 13 patients had achieved excellent response. Patients with endocrinologically active tumors showed normalized hormone levels 24 months after gamma knife surgery except for one patient with acromegaly. The basal value of pituitary hormones remained normal during the follow-up period, and four female patients became pregnant without hormonal therapy. Combined transsphenoidal surgery and gamma knife radiosurgery can preserve normal pituitary function and eradicate adenoma invading the cavernous sinus. Radiat. Oncol. Invest. 6:26–34, 1998. © 1998 Wiley-Liss, Inc.
    Radiation Oncology Investigations 01/1998; 6(1):26 - 34. DOI:10.1002/(SICI)1520-6823(1998)6:1<26::AID-ROI4>3.0.CO;2-K
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    ABSTRACT: To review outcome and treatment sequelae in patients treated with external beam radiotherapy for pituitary adenomas. One hundred forty-one patients with pituitary adenomas received radiotherapy at the University of Florida and had 2-year minimum potential follow-up. One hundred twenty-one had newly diagnosed adenomas, and 20 had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (n = 98) or radiotherapy alone (n = 23). Patients with recurrent tumors received salvage treatment with surgery and radiotherapy (n = 10) or radiotherapy alone (n = 10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on tumor control was analyzed. Tumor control is defined by the absence of radiographic progression and stable or decreased hormone level (in hormonally active tumors) after treatment. Effect of therapy on vision, hormonal function, neurocognitive function, life satisfaction, and affective symptoms were examined. A Likert categorical scale survey was used for assessment of neurocognitive, life satisfaction, and affective symptom status. Survey results from the radiotherapy patients were compared with a control group treated with transsphenoidal surgery alone. Multivariate analysis used the forward step-wise sequence of chi squares for the log rank test. At 10 years, tumor control for the surgery and radiotherapy group (S + RT) was 95% and not statistically different (p = 0.58) than for patients treated with radiotherapy alone (RT) (90%). Patients with prolactin- and ACTH-secreting tumors had significantly worse tumor control, as did patients treated for recurrent tumors. Multivariate analysis for tumor control revealed that only young age was predictive of worse outcome (p = 0.0354). Visual function was either unaffected or improved in most patients, although four patients developed visual loss due to treatment. Hormonal function was affected adversely in 46 of the 93 patients for whom detailed hormonal information was available. Neurocognitive function evaluation revealed that patients in the S + RT group were more likely (p = 0.005) to report difficulty with memory than those in the RT-alone or S-alone groups. No significant difference in life satisfaction or affective symptoms was evident. Pituitary adenomas are well controlled by external beam radiotherapy, either alone or in combination with surgery. Visual symptoms often improve after treatment. Hormonal sequelae require medical intervention in many patients. Neurocognitive sequelae may be different among treatment groups.
    International Journal of Radiation OncologyBiologyPhysics 10/1997; 39(2):437-44. DOI:10.1016/S0360-3016(97)00335-0 · 4.26 Impact Factor
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    ABSTRACT: A total of 112 patients with the diagnosis of nonfunctional pituitary adenoma received radiation therapy at the University of Pittsburgh between 1964 and 1987. Postoperative radiation therapy was administered in 87 patients. Actuarial progression-free survival (tumor control) at 5, 10, 15, and 20 years was 97%, 89%, 87%, and 76%, respectively. Radiation prescribed to the 95% isodose ranged from 35.72 Gy to 62.32 Gy. Multivariate analysis showed decreased tumor control to be significantly associated with increasing field size (P = .036). No improvement in tumor control could be detected with increasing total radiation dose or nominal standard dose (NSD). One patient developed optic neuropathy and another developed a glioblastoma after doses in both patients of 4750 cGy in 25 fractions. External beam radiotherapy for nonfunctional pituitary adenomas was found to be effective and safe when doses less than 4750 cGy in 25 fractions were used.
    Cancer 07/1989; 63(12):2409-14. DOI:10.1002/1097-0142(19890615)63:123.0.CO;2-M · 4.89 Impact Factor
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