Journal article
Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study
Neurosurgery, v 92(5), pp 1035-1042
01 May 2023
PMID: 36700741
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Delayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas.OBJECTIVE: To investigate the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study.METHODS: We retrospectively reviewed the International Radiosurgery Research Foundation database from January 2002 to December 2021 for adult patients undergoing SRS for pituitary adenomas with >6 months of follow-up. Distances between centers or edges of hypothalamic-pituitary axis structures and SRS target volumes were measured using MRI. The primary outcome was anterior pituitary function preservation. Predictors were analyzed using multivariable logistic regression and area under the receiver operating curve (AUROC) curve analyses.RESULTS: Four hundred eighty-seven patients were categorized by preservation (n = 384) and no preservation (n = 103) of anterior pituitary function. The mean margin dose was 19.1(6.2) Gy. Larger distance from the center of the stalk to the tumor margin isodose was a positive predictor (adjusted odds ratio [aOR] = 1.162 [1.046-1.291], P = .005), while pre-SRS hypopituitarism (aOR = 0.646 [0.405-1.031], P = .067) and larger treatment volume (aOR = 0.965 [0.929-1.002], P = .061) were near negative predictors of the primary outcome. An interaction between the treatment volume and center stalk to margin isodose distance was found (aOR = 0.980 [0.961-0.999], P = .045). Center stalk to margin isodose distance had an AUROC of 0.620 (0.557-0.693), at 3.95-mm distance. For patients with treatment volumes of <2.34 mL, center stalk to margin isodose distance had an AUROC of 0.719 (0.614-0.823), at 2.95-mm distance.CONCLUSION: Achieving a distance between the center of the pituitary stalk and the tumor margin isodose =3.95 mm predicted anterior pituitary function preservation. For smaller treatment volumes <2.34 mL, the optimal distance was =2.95 mm. This may be modifiable during trans-sphenoidal resection to preserve pituitary function.
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Details
- Title
- Effects of Neuroanatomic Structural Distances on Pituitary Function After Stereotactic Radiosurgery: A Multicenter Study
- Creators
- Natasha Ironside - University of Virginia Health SystemChing-Jen Chen - Univ Texas Hlth Sci Ctr Houston, Dept Neurosurg, Houston, TX USAZhiyuan Xu - Neurological SurgeryDavid Schlesinger - University of Virginia Health SystemMary Lee Vance - University of Virginia Health SystemGregory K. Hong - University of Virginia Health SystemJr John A. Jane - University of VirginiaSamir Patel - University of AlbertaShray K. Bindal - University of PittsburghAjay Niranjan - University of PittsburghL. Dade Lunsford - University of PittsburghRoman Liscak - Na Homolce HospitalThomas Chytka - Na Homolce HospitalJana Jezkova - Charles UniversityOmran Saifi - Mayo Clinic in FloridaDaniel M. Trifiletti - Jacksonville CollegeAssaf Berger - NYU Langone HealthJuan Alzate - NYU Langone HealthKenneth Bernstein - NYU Langone HealthDouglas Kondziolka - NYU Langone HealthHerwin Speckter - Instituto Tecnológico de Santo DomingoWenceslao Hernandez - Instituto Tecnológico de Santo DomingoErwin Lazo - Instituto Tecnológico de Santo DomingoSelcuk Peker - Koç UniversityYavuz Samanci - Koç UniversityBrad E. Zacharia - Penn State Milton S. Hershey Medical CenterChristine Mau - Penn State Milton S. Hershey Medical CenterRodney E. Wegner - Allegheny Health NetworkMatthew J. Shepard - Allegheny Health NetworkDavid Mathieu - Université de SherbrookeMichel Maillet - Université de SherbrookeJason P. Sheehan - Neurological Surgery
- Publication Details
- Neurosurgery, v 92(5), pp 1035-1042
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000977484700026
- Scopus ID
- 2-s2.0-85152637157
- Other Identifier
- 991022155293604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery