2 ng/ml. The patient was treated with MASEP GKRS, and MRI was performed for treatment planning. 20 Gy defined to the 50% isodose LDK378 cell line line is used to cover the full extent of the pituitary tumor in the first radiosurgery, and 28 Gy defined to the 50% isodose line is used to cover the pituitary tumor in the second time one year later. Figure 6 Typical MRI scan changes in GH adenoma. No significantly enhancing mass lesion is seen in the sella
turcia under the T1-weighted postcontrast MRI scan performed 1 year after the second MASEP GKRS. Patient 3′s clinical symptom did improve. His serum growth hormone level was lower than 10 ng/ml. Regular endocrinological and neuroradiological re-examinations were available in all these patients. The check details data collected as of the end of 2007 are summed up in table 3 and table 4. Table 3 Neuroradiological changes of patients with pituitary adenomas treated with MASEP GKRS Type of adenomas collapse unchanged enlarge enlarged with necrosis ACTH adenomas microadenoma 5 14 2 0 macroadenoma 23 19 3 2 Prolactinomas microadenoma 0 0 0 0 macroadenoma 97 62 12 5 GH adenomas microadenoma 0 0 0 0 macroadenoma 56 42 3 2
Total(%) 181(52.1) 137(39.5) 20(5.8) 9(2.6) 4 patients with ACTH adenomas had repeated MASEP GKRS; 12 patients with prolactinomas had repeated MASEP GKRS; 2 patients with GH adenoma had repeated MASEP GKRS Table 4 Endocrinological changes of patients with pituitary adenomas treated with MASEP GKRS Type of adenomas normalization decrease no improve hypopituitarism
ACTH adenomas microadenoma 7 11 2 1 macroadenoma 12 31 4 0 Prolactinomas microadenoma 0 0 0 0 macroadenoma Megestrol Acetate 41 114 18 3 GH adenomas microadenoma 0 0 0 0 macroadenoma 38 56 7 2 Total(%) 98(28.2) 212(61.1) 31(8.9) 6(1.7) Hypopituitarism occurred in 1 patients with ACTH adenomas after MASEP GKRS; 3 patients with prolactinomas had hypopituitarism after MASEP GKRS; 2 patient with GH adenoma had hypopituitarism after MASEP GKRS Overall 91.6% of tumor control was achieved in 318 with only mild and transient neurological complications in some cases. 28.2% of normalization of hormone level rate and 61.1% of decrease of hormone level rate were also achieved. Hypopituitarism occurred in 6(1.7%) patients who received replacement therapy now. Discussion There are multiple treatment modalities for pituitary adenomas. The individual treatment must be tailored to a patient’s symptoms, overall health, and tumor morphometry. GKRS has been found to be an effective, noninvasive method for treating patients with functioning pituitary adenoma as a complement to the surgery. Tumors that compress the optic pathway should be removed with microsurgery, and residual tumor, especially in the cavernous sinus, is a good indication for radiosurgery.