M. Brada et al., THE LONG-TERM EFFICACY OF CONSERVATIVE SURGERY AND RADIOTHERAPY IN THE CONTROL OF PITUITARY-ADENOMAS, Clinical endocrinology, 38(6), 1993, pp. 571-578
OBJECTIVES We assessed the long-term efficacy and toxicity of conserva
tive surgery and radiotherapy in the control of pituitary adenomas. DE
SIGN Retrospective study of patients treated at the Royal Marsden Hosp
ital. PATIENTS Four hundred and eleven patients with pituitary adenoma
s treated with conventional external beam radiotherapy at the Royal Ma
rsden Hospital between 1962 and 1986. Two hundred and fifty-two patien
ts had clinically non-functioning pituitary adenomas, 131 had hormone
secreting tumours and in 28 patients the secretory status was not know
n. Three hundred and thirty-eight patients had surgical intervention o
f whom only 11 had complete tumour excision. All patients received con
ventional fractionated external beam radiotherapy to a dose of 45-50Gy
in 25-30 fractions. MEASUREMENTS Actuarial progression free survival
and overall survival and assessment of toxicity, particularly in terms
of vision, requirement for hormone replacement therapy and incidence
of second tumours. RESULTS The actuarial progression free survival was
94% at 10 years and 88% at 20 years for all patients and 97% at 10 ye
ars and 92% at 20 years for patients with clinically non-functioning a
denomas. Only secretory status was an independent prognostic factor fo
r disease control. The 10 and 20-year survivals for all patients were
77 and 58% respectively. When compared with the normal population the
relative risk of death was 1.76 (P < 0.001) and no prognostic factors
for survival were identified. The morbidity of radiotherapy was low. V
isual deterioration, assumed to be radiation induced, occurred in 1.5%
of patients and the risk of second brain tumour was 1.9% at 20 years.
Fifty per cent of patients received hormone replacement therapy by 19
years. CONCLUSION Conventional external beam radiotherapy as describe
d here combined with conservative surgery is safe and effective in the
control of pitutary adenomas. These results should form a baseline fo
r comparison with new treatment strategies.