Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland

Purpose: We evaluated survival rates and side effects after fractionated st ereotactically guided radiotherapy and radiosurgery in patients with pituit ary adenoma. Methods and Materials: Between 1989 and 1998, 68 patients were treated with FSRT (n = 63) or radiosurgery (n = 5) pituitary adenomas. Twenty-six had f unctional and 42 had nonfunctional adenomas. Follow-up included CT/MRI, end ocrinologic, and ophthalmologic examinations. Mean follow-up was 38.7 month s. Seven patients received radiotherapy as primary treatment and 39 patient s received it postoperatively for residual disease. Twenty-two patients wer e treated for recurrent disease after surgery. Mean total dose was 52.2 Gy for SCRT, and 15 Gy for radiosurgery. Results: Overall local tumor control was 93% (60/65 patients). Forty-three patients had stable disease based on CT/MRI, while 15 had a reduction of tu mor volume. After FSRT, 26% with a functional adenoma had a complete remiss ion and 19% had a reduction of hormonal overproduction after 34 months' mea n. Two patients with STH-secreting adenomas had an endocrinologic recurrenc e, one with an ACTH-secreting adenoma radiologic recurrence, within 54 mont hs. Reduction of visual acuity was seen in 4 patients and partial hypopitui tarism in 3 patients. None of the patients developed brain radionecrosis or radiation-induced gliomas. Conclusion: Stereotactically guided radiotherapy is effective and safe in t he treatment of pituitary adenomas to improve local control and reduce horm onal overproduction. (C) 2001 Elsevier Science Inc.