Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer

Carolina Benjamin, Kimberly Ashayeri, John G. Golfinos, Dimitris G. Placantonakis, Joshua Silverman, Douglas Kondziolka

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)665-671
Number of pages7
JournalPituitary
Volume23
Issue number6
DOIs
StatePublished - Dec 1 2020

Keywords

  • Endoscopic endonasal approach
  • Gamma knife radiosurgery
  • Metastatic cancer
  • Pituitary adenoma
  • Sellar metastases
  • Stereotactic radiosurgery
  • Transsphenoidal approach

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Fingerprint

Dive into the research topics of 'Treatment of sellar metastases with gamma knife radiosurgery in patients with advanced cancer'. Together they form a unique fingerprint.

Cite this