Douglas Guedes de Castro

Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

ObjectTo assess the effects of radiosurgery (RS) on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas.MethodsRetrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels) and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS.ResultsThe median follow-up was 42 months (6-109 months). The median dose was 12,5 Gy (9 - 15 Gy) and 20 Gy (12 - 28 Gy) for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42) of the cases and tumor shrinkage ocurred in 10% (4 in 42) of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS.ConclusionsRS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly acceptable radiological and hormonal control and absence of complications at this early follow-up are consistent with literature.

Radiosurgery for pituitary adenomas

Pituitary adenomas represent nearly 15% of all intracranial tumors. Multimodal treatment includes microsurgery, medical management and radiotherapy. Microsurgery is the primary recommendation for nonfunctioning and most of functioning adenomas, except for prolactinomas that are usually managed with dopamine agonist drugs. However, about 30% of patients require additional treatment after microsurgery for recurrent or residual tumors. In these cases, fractionated radiation therapy has been the traditional treatment. More recently, radiosurgery has been established as a treatment option. Radiosurgery allows the delivery of prescribed dose with high precision strictly to the target and spares the surrounding tissues. Therefore, the risks of hypopituitarism, visual damage and vasculopathy are significantly lower. Furthermore, the latency of the radiation response after radiosurgery is substantially shorter than that of fractionated radiotherapy. The goal of this review is to define the efficacy, safety and role of radiosurgery for treatment of pituitary adenomas and to present the preliminary results of our institution.

Original Article: Prognostic Factors of Recurrence Pattern, Survival and Toxicity in Patients with Gastric Cancer Treated According to Protocol INT-0116 with 3D-Conformal Radiotherapy

Introduction: Identify clinical and dosimetric variables involved recurrence, toxicity and overall survival of patients with gastric adenocarcinoma treated with surgery and adjuvant chemoradiotherapy according to protocol INT-0116. Methods: Patients treated in AC Camargo Cancer Center between 2001-2008 with R0 resection and 3-D conformal radiotherapy were included. Survival, local control, distant metastases, acute and late toxicity were correlated to clinical and dosimetric parameters through univariate and multivariate analyses. Results: Median follow-up was 42 months, 71 patients were included and 80% underwent D2 lymphadenectomy. The average number of dissected nodes was 33. 69% of patients completed treatment according to the protocol. Actuarial-5year overall survival was 57.3%. 28.2% and 15.5% of the patients had acute toxicity ≥ 3 and developed late toxicity, respectively. Pathological staging and location in gastroesophageal transition or cardia were correlated to worse survival, whereas pathological staging, vascular invasion and lymphatic invasion to worse local control. Patients who failed to conclude protocol showed higher late toxicity. Conclusions: Patients who underwent R0 resection and D2 lymphadenectomy treated according to Protocol INT-0116 with 3-D conformal radiotherapy have reasonable overall survival and local control with moderate toxicity profile. Prognostic factors involved in recurrence, survival and toxicity were found.