AN AUDIT OF SELECTED PATIENTS WITH NONFUNCTIONING PITUITARY-ADENOMA TREATED BY TRANSSPHENOIDAL SURGERY WITHOUT IRRADIATION

OBJECTIVE To determine whether the rate of tumour regrowth in patients with non-functioning pituitary tumour treated by transsphenoidal surg ery and selected for observation without post-operative irradiation is acceptably low, and to identify a group of patients who could appropr iately avoid pituitary irradiation. SUBJECTS One hundred and thirty-tw o patients treated by transsphenoidal surgery, of whom 98 did not unde rgo post-operative irradiation. These 98 were selected as having had a pparently complete surgical removal, and as lacking features of tumour invasion or rapid growth; 73 of them are being followed by serial pit uitary imaging to detect tumour regrowth. RESULTS Forty-two patients w ho have been imaged on two or more occasions or more than two years af ter operation have shown no sign of tumour regrowth; 25 of them have b een imaged at 3 or more years after operation, 13 at more than 5 years , and 4 at more than 10 years. Eight patients have shown regrowth as j udged by imaging, although only one had pressure symptoms at the time; 5 out of 6 of these recurrences were found within 5 years of operatio n (two cannot be timed). The unirradiated group of 73 patients showed 90% recurrence-free survival at 5 years (95% confidence limits 80-100% ). CONCLUSIONS Provided that careful surgery and meticulous recall mec hanisms for imaging can be ensured, patients so selected may be given the information contained in these results and offered the choice of f ollow-up by imaging atone, without pre-emptive irradiation. We recomme nd that they should be imaged 6-8 weeks post-operatively, then at eith er 6 or 12 months depending on the appearance, and then every 3-5 year s for at least 15 years. By this means, many patient-years of good hea lth and relative medical independence can be gained, together with som e financial saving.