• Lindolfo Carlos Heringer, Maíra Machado de Lima, José Marcus Rotta, and Ricardo Vieira Botelho.
• Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil.
• World Neurosurg. 2020 Apr 1; 136: 374-381.e4.

BackgroundIn pituitary tumors, the presence of residual tumor after transsphenoidal surgery and recurrence of the tumor after resection are frequent, and the best treatment is not well established. The effects and complications of stereotactic radiosurgery have not been extensively studied.ObjectiveWe aimed to reveal the effect of stereotactic radiosurgery on residual and recurrent adenomas.MethodsA systematic review of the literature in the MEDLINE/PubMed, Cochrane Central Database, and Google Scholar was conducted using the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was structured according to the PICOT (i.e., Participants, types of Interventions, Comparator between the treatments, types of Outcome measures, and Follow-up [Time of duration]) strategy. The methodologic quality assessment (risk of bias) was performed according to the Methodological Index for Non-Randomized Studies scale. The studies were grouped and analyzed after data extraction using the software "R".ResultsTwenty-six articles including 2315 patients were analyzed, with an average follow-up duration of 57.8 months and mean radiation marginal dose of 19.6 Gy. The overall tumor control rate was 95%, tumor reduction rate was 46%, and hormonal control rate was 67%. The side effects were evaluated.ConclusionsStereotactic radiosurgery was efficient in residual or recurrence tumor control, with few side effects, and is recommended for treating residual or recurrent tumors, both secreting and nonsecreting tumors. A limitation of this study is that there were no randomized trials included in the synthesis.Copyright © 2019 Elsevier Inc. All rights reserved.

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