Intracavitary Yttrium-90 Colloid Therapy for Cystic Sellar Masses: A Phase II Clinical Trial With 5-Year Follow-Up
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Stereotactic intracavitary irradiation of cystic sellar masses (CSMs) with 90-Yttrium colloid ( 90 Y) may mitigate significant morbidity and/or recurrence rates associated with traditional microsurgical resection. In this study, we aimed to prospectively assess the long-term effect of 90 Y on tumor-cyst volume, endocrine, and vision outcomes after treatment of CSMs. METHODS: We conducted a Health Canada-approved, phase II, open label, prospective clinical trial. The primary indication for treatment was clinical evidence of mass effect on initial presentation or subsequent cyst enlargement. Patients underwent right frontal stereotactic insertion of 90 Y (200 Gy to the cyst wall). Cyst volumes were measured using serial MRI. Visual field (VF) assessment and hypothalamic-pituitary hormone panel were obtained. Outcomes were collected postoperatively at 3, 9, and 24 months, then annually up to 5 years. RESULTS: Twenty-two patients (55% women, mean age = 63.6 years [SD 15.4]) received 90 Y. The mean follow-up was 52 months (5-113). Primary diagnoses were the following: craniopharyngioma (86%), Rathke cleft cyst (9%), and cystic prolactinoma (5%). Preoperative clinical features included VF deficit (41%), VF deficit plus headache (36%), or headache alone (13%). For the aggregate cohort, statistically significant reduction in mean tumor-cyst volume for the cohort was observed at all follow-up visits beyond 3 months (all P < .01). At 5-year follow-up, cyst volume reduction was sustained in 82% of cases. The mean percent reduction in tumor-cyst volume was 77.2% (SD 16.8). Ninety-one percent of patients had stable or improved vision postoperatively. The overall proportion of patients with endocrine dysfunction preoperatively (59%) and postoperatively (68%) remained stable ( P > .05). Treatment failure requiring conventional surgery occurred in 3 patients who received 90 Y for cyst recurrence. CONCLUSION: Stereotactic treatment of CSMs with intracavitary 90 Y is associated with sustained reduction in tumor-cyst volume, improved visual function, and stable endocrine function at 5-year follow-up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".