Repeat Stereotactic Radiosurgery for Pituitary Adenomas: A Systematic Review and Meta-Analysis Publisher Pubmed



Hajikarimloo B ; Mohammadzadeh I ; Tos SM ; Mortezaei A ; Habibi MA
Source: Neurosurgical Review Published:2026

Abstract

Repeat stereotactic radiosurgery (SRS) is used for pituitary adenomas (PAs), yet long-term safety and efficacy remain incompletely defined. This systematic review and meta-analysis evaluated radiological control, endocrine outcomes, and adverse effects following repeat SRS. A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted from inception through November 2025. Studies reporting outcomes after repeat SRS for PAs were included. Five studies involving 114 patients were included. The pooled tumor control (TC) rate was 76% (95% CI: 67–84%). Five-year PFS was 75% (95% CI: 29–100%), and 10-year PFS was 60% (95% CI: 49–72%). Endocrine remission (ER) among functioning tumors occurred in 51% (95% CI: 36–67%). New hypopituitarism, adrenal-axis deficit, thyroid-axis deficit, visual deficit, and cranial nerve deficit occurred in 19% (95% CI: 0–74%), 10% (95% CI: 2–22%), 7% (95% CI: 1–18%), 7% (95% CI: 3–12%), and 6% (95% CI: 1–12%), respectively. Adverse radiation events (AREs) occurred in 8% (95% CI: 3–16%). Radiation-induced optic neuropathy (RION) remained extremely rare at 0% (95% CI: 0–2%), and all-cause mortality after repeat SRS was 3% (95% CI: 0–8%). Repeat SRS demonstrates durable radiological control and moderate endocrine efficacy with low rates of severe toxicity, supporting its role as an effective salvage option for selected patients with PAs. However, the evidence is limited by small sample sizes and heterogeneity in reporting, and future multicenter prospective studies are needed to refine patient selection and optimize treatment strategies. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.