Journal of Endocrinological Investigation

, Volume 28, Issue 3, pp 18–22 | Cite as

Experience in management of 51 non-functioning pituitary adenomas: Indications for post-operative radiotherapy

  • C. Alameda
  • T. Lucas
  • E. Pineda
  • M. Brito
  • J. G.-Uría
  • R. Magallón
  • J. Estrada
  • B. Barceló
Original Article


Object: The indications for additional radiotherapy (RT) after surgery for non-functioning pituitary adenoma are controversial. The goal of this retrospective study was to evaluate the outcome of surgically treated patients, with or without post-operative irradiation. Methods: Review of cases treated for non-functioning pituitary adenoma. Fifty-one patients were identified, with a mean post-operative follow-up of 6.4±3.5 yr. Twenty-nine patients showed residual tumor after surgery and 22 did not. Serial endocrine, visual and radiological evaluations were made after treatment to assess the efficacy and toxicity of surgery and RT. Twenty-seven patients with residual tumor after surgery received RT (22 of them during the post-operative period and 5 after an interval of several yr: 3 because of increased tumor size and 2 with stable residual lesion); tumors in 14 of these patients decreased in size, 11 appeared to be stable on imaging and one patient showed some increase in tumor size (one patient was not followed-up). The residual tumors of the 2 non-irradiated patients remained stable after 5 and 7 yr, respectively. Twenty-two patients without residual disease after surgery (11 with post-operative irradiation, 1 with RT 5 yr after transsphenoidal surgery because of tumor recurrence, and 10 without RT) have shown no evidence of tumor regrowth on serial images. Conclusions: Radiotherapy can be avoided in patients with complete macroscopic resection and absence of residual tumor in post-operative images; they must be carefully followed using imaging techniques and, in the case of recurrence, they should be re-operated and/or irradiated.


Pituitary adenoma non-functioning surgery radiotherapy 


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  1. 1.
    Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J. The clinical and endocrine outcome to transsphenoidal microsurgery of non-secreting pituitary adenomas. Cancer 1991, 15: 860–6.CrossRefGoogle Scholar
  2. 2.
    Sassolas G, Trouillas J, Treluyer C, Perrin G. Management of non-functioning pituitary adenomas. Acta Endocrinol (Copenh) 1993, 129: 21–6.Google Scholar
  3. 3.
    Brada M, Rajan B, Traish D, et al. The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 1993, 38: 571–8.CrossRefGoogle Scholar
  4. 4.
    Gittoes NJL, Bates AS, Tse W, et al. Radiotherapy for nonfunctioning pituitary tumours. Clin Endocrinol (Oxf) 1998, 48: 331–7.CrossRefGoogle Scholar
  5. 5.
    Ebersold MJ, Quasi LM, Laws JR, Sceithauer B, Randall RV. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 1986, 64: 713–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ. Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 1994, 30: 557–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Barceló B, Vázquez G, Magallón R. Long term adverse effects of radiotherapy in pituitary tumours. In: Webb SM, ed. Pituitary tumors: Epidemiology, pathogenesis and management. Bristol: Bioscientifica LTD. 1998, 127–47.Google Scholar
  8. 8.
    Bradley KM, Adams CB, Potter PS, Wheeler DW, Anslow PJ, Burke CW. An audit of selected patients with nonfunctioning pituitary adenoma treated by transsphenoidal surgery without irradiation. Clin Endocrinol (Oxf) 1994, 41: 655–9.CrossRefGoogle Scholar
  9. 9.
    Arafah BM. Reversible hypopituitarism in patients with large non-functioning pituitary adenomas. J Clin Endocrinol Metab 1986, 62: 1173–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Bevan JS, Adams CBT, Burke CW, et al. Factors in the outcome of transsphenoidal surgery for prolactinoma and nonfunctioning pituitary tumour, including preoperative bromocriptine therapy. Clin Endocrinol (Oxf) 1987, 26: 541–56.CrossRefGoogle Scholar
  11. 11.
    Grant FC. Surgical experience with tumours of the pituitary gland. JAMA 1948, 136: 668–72.CrossRefGoogle Scholar
  12. 12.
    Emmanuel IG. Symposium on pituitary tumours: (3) Historical aspects of radiotherapy, present treatment technique, and results. Clin Radiol 1966, 17: 154–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Ray RS, Patterson RH. Surgical experience with chromophobe adenomas of the pituitary gland. J Neurosurg 1971, 34: 726–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Sheline G. Treatment of non-functioning adenomas of the pituitary. Am J Roentgenol 1974, 120: 553–61.CrossRefGoogle Scholar
  15. 15.
    Sheline GE, Tyrrell B. Pituitary adenomas. In: Phillips TL, Pistenma DA, eds. Radiation Oncology Annual. New York: Raven Press. 1983, 1–35.Google Scholar
  16. 16.
    McCollough WM, Marcus RB, Rhoton AL, Ballinger WE, Million RR. Long-term follow-up of radiotherapy for pituitary adenoma: the absence of late recurrence after > 4500 cGy. Int J Radiat Oncol Biol Phys 1991, 21: 607–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Ciric I, Mikhael M, Stafford T, Lawson L, Garces R. Transsphenoidal microsurgery of pituitary macroadenomas with longterm follow-up results. J Neurosurg 1983, 59: 395–401.PubMedCrossRefGoogle Scholar
  18. 18.
    Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, Ridgway EC. Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery 1998, 43: 432–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Turner EH, Stratton IM, Byrne JV, Adams CTB, Wass JAH. Audit of selected patients with nonfunctional pituitary adenomas treated without irradiation — a follow-up study. Clin Endocrinol (Oxf) 1999, 51: 281–4.CrossRefGoogle Scholar
  20. 20.
    Bradley KJ, Was JA, Turner HE. Non-functioning pituitary adenomas with positive immunoreactivity for ACTH behave more aggressively than ACTH immunonegative tumours but do not recur more frequently. Clin Endocrinol (Oxf) 2003, 58: 59–64.CrossRefGoogle Scholar
  21. 21.
    Adams CBT, Burke CW. Current modes of treatment of pituitary tumours. Br J Neurosurg 1993, 7: 123–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Chun M, Masko GB, Hetelekidis S. Radiotherapy in the treatment of pituitary adenomas. Int J Radiat Oncol Biol Phys 1988, 15: 305–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Kovalic JJ, Grigsby PW, Fineberg BB. Recurrent pituitary adenomas after surgical resection: the role of radiation therapy. Radiology 1990, 177: 273–5.PubMedGoogle Scholar
  24. 24.
    Breen P, Flickinger JC, Kondziolka D, Martinez A. Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control. J Neurosurg 1998, 89: 933–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Plowman PN. Pituitary adenoma radiotherapy-when, who and how? Clin Endocrinol (Oxf) 1999, 51: 265–71.CrossRefGoogle Scholar
  26. 26.
    Boelaert K, Gittoes N. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 2001, 144: 569–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Woollon AC, Hunn MK, Rajapakse YR. Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf) 2000, 53: 713–7.CrossRefGoogle Scholar
  28. 28.
    Brada M, Rajan B, Ashley S, et al. Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenomas. Br Med J 1992, 304: 1343–6.CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2005

Authors and Affiliations

  • C. Alameda
    • 1
  • T. Lucas
    • 1
  • E. Pineda
    • 1
  • M. Brito
    • 1
  • J. G.-Uría
    • 2
  • R. Magallón
    • 3
  • J. Estrada
    • 1
  • B. Barceló
    • 1
  1. 1.Department of Endocrinology, Hospital Universitario, Puerta de HierroUniversidad Autónoma de MadridMadridSpain
  2. 2.Department of Neurosurgery, Hospital UniversitarioUniversidad Autónoma de MadridMadridSpain
  3. 3.Radiation Oncology, Hospital Universitario Puerta de HierroUniversidad Autónoma de MadridMadridSpain

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