Therapeutic Hypopituitarism Induced by Stereotaxic Transfrontal Implantation of Yttrium-90 in Patients with Breast Cancer

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Abstract
Forty-three patients with breast cancer were submitted to stereotaxic transfrontal implantation of 90Y under local anesthesia. No immediate deaths occurred. Four patients were implanted twice. The first 19 patients received doses ranging between 7.1 and 15.5 me Three showed visual damage due to high location of pellets in the sella turcica. The remaining 24 patients received doses between 18.1 and 23.4 mc, which were placed deep in the floor of the sella. No visual damage occurred. Eight patients presented with rhinorrhea, in 3 of whom it ceased spontaneously after 2 or 3 months; 2 others are under observation; and 3 presented with meningitis, one of whom recovered and 2 died. Necropsy of these patients showed destruction of the bone and bone marrow and devitalization of the epithelium in the sella and the sphenoidal sinus. Urinary gonadotrophins, 131I thyroid uptake and response to Metopirone showed that complete hypopituitarism was obtained in 23 cases (62%). Hypopituitarism was considered incomplete in 14 cases (38%). Six patients were not fully studied. Necropsy studies were done in 9 patients, 2 of whom showed complete histological destruction of the gland. In the remaining patients destruction was estimated to be between 60 and 97%. Objective remission of metastases of breast cancer lasting more than 6 months occurred in 27% of the total series and in 35% of patients with complete hypopituitarism. The authors recommend a total dose of 90Y of approximately 15 mc distributed in 8 or more small pellets to obtain complete destruction of the gland and placement of pellets at least 3 mm below the diaphragm of the sella and 2 mm above its floor to prevent complications. The procedure is considered a useful method for obtaining therapeutic hypopituitarism.

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