S354
Clinical - CNS
ESTRO 2026
clearly. Keywords: Radiosurgery; Pituitary adenoma; Repeated
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Repeat Radiosurgery for Pituitary Adenomas: A Systematic Review and Meta-Analysis of Efficacy and Safety Fatemeh Jafari 1 , Mohaddese Poodine 2 , Eyub Yasar Akdemir 3 , Fateme Javan 2 , Arad Iranmehr 4 , Mohadeseh Mohammad Taheri 2 1 Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of. 2 Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran, Islamic Republic of. 3 Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, Iran, Islamic Republic of. 4 Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of Purpose/Objective: Stereotactic radiosurgery can be the preferred option for treating pituitary adenomas in patients with non- functioning tumors who are not surgical candidates, in those with functioning tumors unresponsive to medical therapy, or in the adjuvant setting for residual or recurrent disease after resection. However, some patients require repeat radiosurgery due to residual pituitary adenomas after the first line treatment. This systematic review and meta-analysis aimed to investigate the safety and efficacy of repeat radiosurgery in the management of refractory/recurrent pituitary adenomas. Material/Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. The search was conducted on PubMed, Scopus, and Web of Science databases using a pre-designed search string. Studies investigating the efficacy of repeat radiosurgery for refractory/recurrent pituitary adenomas following initial single session radiosurgery were included. Results: Five studies, involving 157 patients who underwent repeat radiosurgery for refractory/recurrent pituitary adenomas were eligible for inclusion. These retrospective cohort studies were performed across many institutions located in Italy, China, and other countries, published between 1991 and 2021.The pooled success rate for tumor control following repeat radiosurgery was 85% (95% CI: 69%–93%). Tumor shrinkage was observed in 69% (95% CI: 60-77%) of patients. Adverse events, including new neurological deficits and radiation-induced optic neuropathy, were reported in 7.5% (95% CI: 4% -15%) of patients. Conclusion: Repeat radiosurgery is a viable, effective, and safe option for treating pituitary adenomas after the failure of initial radiosurgery. Further studies are needed to define patient selection and optimal doses more
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Radiation-Induced Optic Neuropathy Following Proton Therapy for Skull Base, and Head and Neck Tumors: A Systematic Review and Meta-Analysis Tiuri E Kroese, Alessandra Bolsi, Arturs Meijers, Damien C. Weber Center for Proton Therapy (CPT), Paul Scherrer Institut (PSI), Villigen, Switzerland Purpose/Objective: Radiation-induced optic neuropathy (RION) is a rare but serious complication of radiotherapy, leading to potentially irreversible vision loss. This systematic review and meta-analysis aimed to determine the prevalence of RION in adult patients treated with proton therapy for intracranial, skull base, or head and neck tumors, and to identify predictors of RION. Material/Methods: Studies published after year 2000 reporting on the prevalence of RION in ≥ 10 adult patients who underwent proton therapy for intracranial, skull base, or head and neck tumors were eligible for inclusion. Study quality assessment was performed using the ROBINS-I tool. The primary outcome was the prevalence of RION (any grade). The secondary outcome were predictors of RION. Results: A total of 29 studies comprising 2’385 patients were included. All studies were retrospective. Treatment modalities were proton-only radiotherapy (n=15), planned combined proton-photon radiotherapy (n=11), or unplanned combined proton-photon radiotherapy (n=3). The most frequently included tumors were head and neck cancers (n=10), meningiomas (n=7) and chordoma/chondrosarcoma (n=4). Overall risk of bias was serious in 11 (37%) studies or moderate in 18 (63%) studies. Median follow-up time was 45 months (interquartile range [IQR]: 30-62). The pooled prevalence of RION was 5% (95% confidence interval [CI]: 4-7%). Subgroup analyses showed a significant higher prevalence of RION in studies published between 2000–2014 vs. 2015–2025 (8% vs. 5%, respectively, p=0.032) and in proton-only radiotherapy compared to planned or unplanned combined photon-proton radiotherapy (7% vs. 4% and 2%, respectively, p=0.025). Figure 1: Forest plots demonstrating subgroup analysis on the year of publication and the prevalence RION across individual studies along with the pooled estimate.
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