1 INTRODUCTION Pituitary adenomas is a disease that has diversified clinical symptoms In 2007, Vietnam began to apply gamma knife radiotherapy to treat brain tumors including patients with pituitary tumors, but no reports have been released of the clinical and subclinical changes after the treatment In order to answer the above issues, we conducted a study entitled "Research on the changes of clinical symptoms, images and pituitary function in patients with pituitary adenomas before and after treatment with rotating gamma knife” Objectives: Describe clinical and sub-clinical characteristics of patients with pituitary tumors Assessment of clinical and subclinical changes in patients with pituitary tumors before and after surgery Study Rationales: Pituitary tumors account for 10-15% of intracranial tumors Radiographically applied gamma rays converge precisely at the lesion and should be effective for treatment Studies to evaluate morphologic changes and pituitary function before and after radiotherapy of patients with pituitary tumors are important to contribute to the indications of the therapy as well as assessment of radiation complications for treatment of pituitary tumors New contribution of the Dissertation: - Established indications in surgical patients who have not taken all the tumors, recurrence after surgery or medical treatment failures that can not be surgically removed and the tumor size is 0,05 < 0,01 Median GH levels in women are higher than men, ACTH in women is lower than men, PRL, LH, FSH, TSH hormones were equivalent in males and females Table 3.17 Comparision of median of hormon level in nonfunctioning pituirity adenomas group by sex Hormone PRL (ng/ml) LH (mU/ml) FSH (mU/l) ACTH (pg/ml) TSH (µU/l) GH (ng/ml) Median (min-max) Median (min-max) Median (min-max) Median (min-max) Median (min-max) Median (min-max) Male (n=17) 9,01 4,37-19,12 5,30 0,52-11,78 6,35 3,45-15,51 21,02 10,8254,92 0,99 0,23-2,30 2,31 0,13-5,32 Female (n=24) 10,92 3,44-21,14 5,33 1,00-12,01 5,78 1,95-11,87 Total (n=41) 10,02 3,44-21,14 5,30 0,52-12,01 6,24 1,95-15,51 20,88 1,00-45,93 21,02 1,00-54,92 1,60 0,60-4,78 2,16 0,37-5,32 1,52 0,06-4,78 2,19 0,13-5,32 p >0,05 >0,05 >0,05 >0,05 >0,05 >0,05 Median hormonal concentrations in the nonfunctioning pituirity adenomas group in men and women were similar Figure 3.2 Correlation between tumor size and PRL level in PRL-released patients 11 The tumor size was not significant correlated with hormone levels PRL was positively correlated with tumor size and PRL level with r = 0.42, p = 0.04 3.3 Results of radiotherapy 3.3.1 General characteristics of the patients and radiation dose 12 Table 3.20 Age and sex of the radiosurgery group Functioning Nonfunctioning pituirity pituirity Total Indicators adenomas adenomas (n=48) (n=21) (n=27) Age (year) 40,8±10,1 47,5±13,6 44,6±12,8 Ratio Female/Male 17/4 15/12 32/16 Discharge (day) 1,9 ±1,04 2,1± 2,4 2,0± 1,9 X± SD, (Min-max) (1-4) (1-13) (1-13) Follow-up after surgery 40,7± 9,7 37,1± 11,8 38,7±10,9 (month) X± SD, (Min-max) (24-56) (12-63) (12-63) Mean age was 44.6 ± 12.3 years, mean hospital stay was 2.0 ± 1.9 days, mean follow-up was 38.7 ± 10.9 months Table 3.21 Previous radiosurgery treatment Radiosurgery treatment (n=48) Previous radiosurgery Percentage treatment Quantity (n) (%) No treatment 12,5 Medical treatment 29 60,4 Surgical treatment 14,6 Medical + Surgical treatment 12,5 Total 48 100 87,5% of the patients was treated before surgery Table 3.22 Distribution of radiation dose Group Functioning Non-functioning Total Dose Pituirity pituirity (n=48) (Gy) adenomas (n=21) adenomas (n=27) Mean ( X ± SD) 14,05 ± 2,89 13,20 ± 1,36 13,61 ± 2,18 Min 11 12 11 Max 22 16 22 p >0,05 Average radiation dose: 13,61±2,18Gy (11-22Gy) 3.3.2 Clinical response after surgery 3.3.2.2 Clinical response in PRL functioning pituirity adenomas group 13 Figure 3.3 Clinical symptoms before and after treatment in PRL group Symptoms of headache, galactorrhea, menstrual disorders, infertility over time as compared to before treatment 3.3.2.2 Clinical response in GH functioning pituirity adenomas group Figure 3.4 Clinical symptom of GH increasement before and after treatment 100% of the patients with acromegaly at any assement timepoints 3.3.2.2 Clinical response in non functioning pituirity adenomas group Figure 3.5 Clinical symptoms in nonfunctioning pituirity adenomas group before and after treatment Headache, Visual disorders, Memory loss reduced significantly after 12 months 14 3.3.3 Response by tumor imaging after surgery Table 3.25 Comparision of the average size of tumors before and after surgery in functioning pituirity adenomas and nonfunctioning pituirity adenomas Functioning pituirity Nonfunctioning pituirity adenomas adenomas Assessment point n n ( X ± SD) ( X ± SD) Before surgery (0) 21 22,1±9,9 27 20,1±10,8 After months (1) 20 19,6±10,1 26 19,4±12,7 After 12 months (2) 18 15,9±12,7 26 15,5±12,2 After 24 months (3) 20 13,1±14,2 19 12,8±11,2 After 36 months (4) 15 12,2±14,0 20 13,4±11,4 P0-10,05 p P -2,3,4