The Impact Of Using Antisecretory Medications On The Pituitary Endocrine Remission Rate At Peri-treatment Period Of Gamma Knife Raiosurgery For Functional Pituitary Adenomas:A Meta-analysis

Background and Objective Gamma knife has been widely used in the treatment of pituitary adenomas and its efficacy has been evaluated by a great deal of research.There has been a debate on the impact of using antisecretory medications on endocrine remission during peri-treatment period of Gamma knife radiosurgery for functional pituitary adenomas,while analysing factors associated with endocrine remission.Therefore,this research aims to evaluate the impact of using antisecretory medications on endocrine remission during peri-treatment period of Gamma knife radiosurgery for functional pituitary adenomas through Meta-analysis.Methods The databases including Pubmed,Cochrane library,Google scholar and Wiley Online were retrieved to collect trials about the impact of using antisecretory medications on endocrine remission during peri-treatment period of Gamma knife radiosurgery for functional pituitary adenomas from the date of their establishment to July 2016,and the probably relevant references of included studies were also retrieved manually.Studies were read,data were extracted,and methodological quality were evaluated by two participants independently.Meta-analyses were conducted by using Rev Man5.3 and Stata12.0 software.Results A total of 500 cases from 12 studies were included,206 of them in exposure group and 294 participants in control group.The result of this meta-analysis shows that the endocrine remission rate of exposure group patients was 51% of that of control group's,RR=0.51(95%CI 0.39 to 0.65),and the difference is statistically significant(P=0.03).Subgroup analyses revealed that the endocrine remission rate of exposure group was 85% lower than that of control group,while mean follow-up time was less than 36 months,and the rate was just 40% lower,while mean follow-up time was more than 36 months,there was a significant different between these two sub-groups(P=0.02).Conclusion Currently,the limited evidence shows that using antisecretory medications during peri-treatment period of Gamma knife kadiosurgery would decrease the rate of endocrine remission for functional pituitary adenomas,so antisecretory medications should be quit before and after Gamma knife kadiosurgery,when clinically feasible.However,this conclusion has to be further verified by high quality,large scale and double blinded prospective randomized controlled trials.