, Volume 21, Issue 2, pp 154–161 | Cite as

Management of nonfunctioning pituitary tumors: radiotherapy

  • Giuseppe Minniti
  • John Flickinger
  • Barbara Tolu
  • Sergio Paolini


External beam radiotherapy (RT) is an essential part of the management of intracranial tumors and has been used in treating pituitary adenomas for more than five decades. It has been demonstrated that conventional RT for postoperative residual or progressive nonfunctioning pituitary adenomas (NFAs) present an excellent long-term local tumor control, although its use has been limited because of the potential late toxicity related to radiation treatments. Recent advances in radiation techniques have led to more accurate treatments, rendering obsolete many commonly held views of the “old” radiotherapy. New techniques include intensity modulated radiotherapy, volumetric-modulated arc therapy, and stereotactic techniques, either stereotactic radiosurgery or fractionated stereotactic radiotherapy. New techniques allow the delivering of higher radiation doses to the target with rapid dose fall-off in the surrounding normal tissues, and potentially limiting the long term toxicity of radiation. In this review, we present a critical analysis of the most recent available literature on the use of radiation in patients with NFAs, focusing particularly on the efficacy and safety of radiation stereotactic techniques.


Radiosurgery Fractionated stereotactic radiotherapy Nonfunctioning pituitary adenoma Survival Local control Hypopituitarism 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Dekkers OM, Pereira AM, Romijn JA (2008) Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab 93(10):3717–3726CrossRefPubMedGoogle Scholar
  2. 2.
    Murad MH, Fernández-Balsells MM, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, Ponce de León-Lovatón PG, Albuquerque FN, Carey J, Erwin PJ, Montori VM (2003) Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol 73(6):777–791CrossRefGoogle Scholar
  3. 3.
    Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M (2005) Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 56(6):1222–1233CrossRefPubMedGoogle Scholar
  4. 4.
    Minniti G, Jaffrain-Rea ML, Osti M, Cantore G, Enrici RM (2007) Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques. Neurosurg Rev 30(3):167–175CrossRefPubMedGoogle Scholar
  5. 5.
    Boelaert K, Gittoes NJ (2001) Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinology 144(6):569–575CrossRefGoogle Scholar
  6. 6.
    Al-Mefty O, Kersh JE, Routh A, Smith RR (1990) The long-term side effects of radiation therapy for benign brain tumours in adults. J Neurosurgery 73(4):502–512CrossRefGoogle Scholar
  7. 7.
    McCord MW, Buatti JM, Fennell EM, Mendenhall WM, Marcus RB Jr, Rhoton AL, Grant MB, Friedman WA (1997) Radiotherapy for pituitary adenoma: long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 39(2):437–444CrossRefPubMedGoogle Scholar
  8. 8.
    Peace KA, Orme SM, Padayatty SJ, Godfrey HP, Belchetz PE (1998) Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication. Clin Endocrinol 49(3):391–396CrossRefGoogle Scholar
  9. 9.
    Guinan EM, Lowy C, Stanhope N, Lewis PD, Kopelman MD (1998) Cognitive effects of pituitary tumours and their treatments: two case studies and an investigation of 90 patients. J Neurol Neurosurg Psychiatry 65(6):870–876CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Brada M, Burchell L, Ashley S, Traish D (1999) The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys 45(3):693–698CrossRefPubMedGoogle Scholar
  11. 11.
    Flickinger JC, Nelson PB, Taylor FH, Robinson A (1989) Incidence of cerebral infarction after radiotherapy for pituitary adenoma. Cancer 63(12):2404–2408CrossRefPubMedGoogle Scholar
  12. 12.
    van Varsseveld NC, van Bunderen CC, Ubachs DH, Franken AA, Koppeschaar HP, van der Lely AJ, Drent ML (2015) Cerebrovascular events, secondary intracranial tumors, and mortality after radiotherapy for nonfunctioning pituitary adenomas: a subanalysis from the Dutch National Registry of Growth Hormone Treatment in Adults. J Clin Endocrinol Metab 100(3):1104–1112CrossRefPubMedGoogle Scholar
  13. 13.
    Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90(2):800–804CrossRefPubMedGoogle Scholar
  14. 14.
    Minniti G, Gilbert DC, Brada M (2009) Modern techniques for pituitary radiotherapy. Rev Endocr Metab Disord 10(2):135–144CrossRefPubMedGoogle Scholar
  15. 15.
    Leber KA, Berglöff J, Pendl G (1998) Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88(1):43–50CrossRefPubMedGoogle Scholar
  16. 16.
    Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27(2):215–221CrossRefPubMedGoogle Scholar
  17. 17.
    Stafford SL, Pollock BE, Leavitt JA, Foote RL, Brown PD, Link MJ, Gorman DA, Schomberg PJ (2003) A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 55(5):1177–1181CrossRefPubMedGoogle Scholar
  18. 18.
    Leavitt JA, Stafford SL, Link MJ, Pollock BE (2013) Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 87(3):524–527CrossRefPubMedGoogle Scholar
  19. 19.
    Mayo C, Martel MK, Marks LB, Flickinger J, Nam J, Kirkpatrick J (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 76(3 Suppl):S28–S35CrossRefPubMedGoogle Scholar
  20. 20.
    Meeks SL, Buatti JM, Foote KD, Friedman WA, Bova FJ (2000) Calculation of cranial nerve complication probability for acoustic neuroma radiosurgery. Int J Radiat Oncol Biol Phys 47(3):597–602CrossRefPubMedGoogle Scholar
  21. 21.
    Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97(5Suppl):415–421PubMedGoogle Scholar
  22. 22.
    Vladyka V, Liscák R, Novotný J Jr, Marek J, Jezková J (2003) Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery 52:309–316CrossRefPubMedGoogle Scholar
  23. 23.
    Leenstra JL, Tanaka S, Kline RW, Brown PD, Link MJ, Nippoldt TB et al (2010) Factors associated with endocrine deficits after stereotactic radiosurgery of pituitary adenomas. Neurosurgery 67:27–32CrossRefPubMedGoogle Scholar
  24. 24.
    Marek J, Jezková J, Hána V, Krsek M, Bandúrová L, Pecen L, Vladyka V, Liscák R (2011) Is it possible to avoid hypopituitarism after irradiation of pituitary adenomas by the Leksell gamma knife? Eur J Endocrinol 164:169–178CrossRefPubMedGoogle Scholar
  25. 25.
    Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML (2011) Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 114:303–309CrossRefPubMedGoogle Scholar
  26. 26.
    Sicignano G, Losa M, del Vecchio A, Cattaneo GM, Picozzi P, Bolognesi A, Mortini P, Calandrino R (2012) Dosimetric factors associated with pituitary function after Gamma Knife Surgery (GKS) of pituitary adenomas. Radiother Oncol 104:119–124CrossRefPubMedGoogle Scholar
  27. 27.
    Kuo JS, Yu C, Petrovich Z, Apuzzo ML (2008) The CyberKnife stereotactic radiosurgery system: description, installation, and an initial evaluation of use and functionality. Neurosurgery 162(Suppl 2):785–789Google Scholar
  28. 28.
    Lamba M, Breneman JC, Warnick RE (2009) Evaluation of image-guided positioning for frameless intracranial radiosurgery. Int J Radiat Oncol Biol Phys 74(3):913–919CrossRefPubMedGoogle Scholar
  29. 29.
    Wurm RE, Erbel S, Schwenkert I, Gum F, Agaoglu D, Schild R, Schlenger L, Scheffler D, Brock M, Budach V (2008) Novalis frameless image-guided noninvasive radiosurgery: initial experience. Neurosurgery 62(5 Suppl):A11–A17CrossRefPubMedGoogle Scholar
  30. 30.
    Ramakrishna N, Rosca F, Friesen S, Tezcanli E, Zygmanszki P, Hacker F (2010) A clinical comparison of patient setup and intra-fraction motion using frame based radiosurgery versus a frameless image-guided radiosurgery system for intracranial lesions. Radiother Oncol 95:109–115CrossRefPubMedGoogle Scholar
  31. 31.
    Gevaert T, Verellen D, Tournel K, Linthout N, Bral S, Engels B, Collen C, Depuydt T, Duchateau M, Reynders T, Storme G, De Ridder M (2012) Setup accuracy of the Novalis ExacTrac 6DOF system for frameless radiosurgery. Int J Radiat Oncol Biol Phys 82:1627–1635CrossRefPubMedGoogle Scholar
  32. 32.
    Kim H, Potrebko P, Rivera A, Liu H, Eldredge-Hindy HB, Gunn V, Werner-Wasik M, Andrews DW, Evans JJ, Farrell CJ, Judy K, Shi W (2015) Tumor volume threshold for achieving improved conformity in VMAT and gamma knife stereotactic radiosurgery for vestibular schwannoma. Radiother Oncol 115(2):229–234CrossRefPubMedGoogle Scholar
  33. 33.
    Ronson BB, Schulte RW, Han KP, Loredo LN, Slater JM, Slater JD (2006) Fractionated proton beam irradiation of pituitary adenomas. Int J Radiat Oncol Biol Phys 64(2):425–434CrossRefPubMedGoogle Scholar
  34. 34.
    Petit JH, Biller BM, Coen JJ, Swearingen B, Ancukiewicz M, Bussiere M, Chapman P, Klibanski A, Loeffler JS (2007) Proton stereotactic radiosurgery in management of persistent acromegaly. Endocr Pract 13(7):726–734CrossRefPubMedGoogle Scholar
  35. 35.
    Petit JH, Biller BM, Yock TI, Swearingen B, Coen JJ, Chapman P, Ancukiewicz M, Bussiere M, Klibanski A, Loeffler JS (2008) Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas. J Clin Endocrinol Metab 93(2):393–399CrossRefPubMedGoogle Scholar
  36. 36.
    Grigsby PW, Simpson JR, Emami BN, Fineberg BB, Schwartz HG (1989) Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 16(6):1411–1417CrossRefPubMedGoogle Scholar
  37. 37.
    McCollough WM, Marcus RB Jr, Rhoton AL Jr, Ballinger WE, Million RR (1991) Long-term follow-up of radiotherapy for pituitary adenoma: the absence of late recurrence after greater than or equal to 4500 cGy. Int J Radiat Oncol Biol Phys 21(3):607–614CrossRefPubMedGoogle Scholar
  38. 38.
    Brada M, Rajan B, Traish D, Ashley S, Holmes-Sellors PJ, Nussey S, Uttley D (1993) The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol 38(6):571–578CrossRefGoogle Scholar
  39. 39.
    Tsang RW, Brierly JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ (1994) Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 30(3):557–565CrossRefPubMedGoogle Scholar
  40. 40.
    Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M (1995) External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33(2):307–314CrossRefPubMedGoogle Scholar
  41. 41.
    Rush S, Cooper PR (1997) Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macroadenomas. Int J Radiat Oncol Biol Phys 37(5):1031–1034CrossRefPubMedGoogle Scholar
  42. 42.
    Breen P, Flickinger JC, Kondziolka D, Martinez AJ (1998) Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumour control. J Neurosurg 89(6):933–938CrossRefPubMedGoogle Scholar
  43. 43.
    Gittoes NJ, Bates AS, Tse W, Bullivant B, Sheppard MC, Clayton RN, Stewart PM (1998) Radiotherapy for non-function pituitary tumours. Clin Endocrinol 48(3):331–337CrossRefGoogle Scholar
  44. 44.
    Sasaki R, Murakami M, Okamoto Y, Kono K, Yoden E, Nakajima T, Nabeshima S, Kuroda Y (2000) The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys 47(5):1337–1345CrossRefPubMedGoogle Scholar
  45. 45.
    Langsenlehner T, Stiegler C, Quehenberger F, Feigl GC, Jakse G, Mokry M, Langsenlehner U, Kapp KS, Mayer R (2007) Long-term follow-up of patients with pituitary macroadenomas after postoperative radiation therapy: analysis of tumor control and functional outcome. Strahlenther Onkol 183(5):241–247CrossRefPubMedGoogle Scholar
  46. 46.
    Rim CH, Yang DS, Park YJ, Yoon WS, Lee JA, Kim CY (2011) Radiotherapy for pituitary adenomas: long-term outcome and complications. Radiat Oncol J 29(3):156–163CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Sebastian P, Balakrishnan R, Yadav B, John S (2016) Outcome of radiotherapy for pituitary adenomas. Rep Pract Oncol Radiother 21(5):466–472CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Scheick S, Amdur RJ, Kirwan JM, Morris CG, Mendenhall WM, Roper S, Friedman W (2016) Long-term outcome after fractionated radiotherapy for pituitary adenoma: the curse of the secretory tumor. Am J Clin Oncol 39(1):49–54CrossRefPubMedGoogle Scholar
  49. 49.
    Woollons AC, Hunn MK, Rajapakse YR, Toomath R, Hamilton DA, Conaglen JV, Balakrishnan V (2000) Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol 53(6):713–717CrossRefGoogle Scholar
  50. 50.
    Park P, Chandler WF, Barkan AL, Orrego JJ, Cowan JA, Griffith KA, Tsien C (2004) The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 55(1):100–106CrossRefPubMedGoogle Scholar
  51. 51.
    Tsang RW, Laperriere NJ, Simpson WJ, Brierley J, Panzarella T, Smyth HS (1993) Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk. Cancer 72(7):2227–2233CrossRefPubMedGoogle Scholar
  52. 52.
    Feigl GC, Bonelli CM, Berghold A, Mokry M (2002) Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 97(5 Suppl):415–421PubMedGoogle Scholar
  53. 53.
    Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for residual or recurrent non-functioning pituitary adenoma. J Neurosurg 97(5 Suppl):408–414PubMedGoogle Scholar
  54. 54.
    Wowra B, Stummer W (2002) Efficacy of gamma knife radiosurgery for non-functioning pituitary adenomas: a quantitative follow-up with magnetic resonance imaging-based volumetric analysis. J Neurosurg 97(5 Suppl):429–432PubMedGoogle Scholar
  55. 55.
    Petrovitch Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML (2003) Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53(1):51–59CrossRefGoogle Scholar
  56. 56.
    Losa M, Valle M, Mortini P, Franzin A, da Passano CF, Cenzato M, Bianchi S, Picozzi P, Giovanelli M (2004) Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg 100(3):438–444CrossRefPubMedGoogle Scholar
  57. 57.
    Muacevic A, Uhl E, Wowra B (2004) Gamma knife radiosurgery for nonfunctioning pituitary adenomas. Acta Neurochir Suppl 91:51–54PubMedGoogle Scholar
  58. 58.
    Iwai Y, Yamanaka K, Yoshioka K (2005) Radiosurgery for nonfunctioning pituitary adenomas. Neurosurgery 56(4):699–705CrossRefPubMedGoogle Scholar
  59. 59.
    Picozzi P, Losa M, Mortini P, Valle MA, Franzin A, Attuati L, da Passano CF, Giovanelli M (2005) Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas. J Neurosurg 102(Suppl):71–74CrossRefGoogle Scholar
  60. 60.
    Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER, Steiner L (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104(6):876–883CrossRefPubMedGoogle Scholar
  61. 61.
    Voges J, Kocher M, Runge M, Poggenborg J, Lehrke R, Lenartz D, Maarouf M, Gouni-Berthold I, Krone W, Muller RP, Sturm V (2006) Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study. Cancer 107:1355–1364CrossRefPubMedGoogle Scholar
  62. 62.
    Liscák R, Vladyka V, Marek J, Simonová G, Vymazal J (2007) Gamma knife radiosurgery for endocrine-inactive pituitary adenomas. Acta Neurochir 149(10):999–1006CrossRefPubMedGoogle Scholar
  63. 63.
    Pollock BE, Cochran J, Natt N, Brown PD, Erickson D, Link MJ, Garces YI, Foote RL, Stafford SL, Schomberg PJ (2008) Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys 70(5):1325–1329CrossRefPubMedGoogle Scholar
  64. 64.
    Kobayashi T (2009) Long-term results of stereotactic gamma knife radiosurgery for pituitary adenomas. Specific strategies for different types of adenoma. Prog Neurol Surg 22:77–95CrossRefPubMedGoogle Scholar
  65. 65.
    Hayashi M, Chernov M, Tamura N, Nagai M, Yomo S, Ochiai T, Amano K, Izawa M, Hori T, Muragaki Y, Iseki H, Okada Y, Takakura K (2010) Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol 98(2):185–194CrossRefPubMedGoogle Scholar
  66. 66.
    Gopalan R, Schlesinger D, Vance ML, Laws E, Sheehan J (2011) Long-term outcomes after Gamma Knife radiosurgery for patients with a nonfunctioning pituitary adenoma. Neurosurgery 69(2):284–293CrossRefPubMedGoogle Scholar
  67. 67.
    Iwata H, Sato K, Tatewaki K, Yokota N, Inoue M, Baba Y, Shibamoto Y (2011) Hypofractionated stereotactic radiotherapy with CyberKnife for nonfunctioning pituitary adenoma: high local control with low toxicity. Neuro Oncol 13(8):916–922CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Park KJ, Kano H, Parry PV, Niranjan A, Flickinger JC, Lunsford LD, Kondziolka D (2011) Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery 69(6):1188–1199CrossRefPubMedGoogle Scholar
  69. 69.
    Starke RM, Williams BJ, Jane JA Jr, Sheehan JP (2012) Gamma Knife surgery for patients with nonfunctioning pituitary macroadenomas: predictors of tumor control, neurological deficits, and hypopituitarism. J Neurosurg 117(1):129–135CrossRefPubMedGoogle Scholar
  70. 70.
    Runge MJ, Maarouf M, Hunsche S, Kocher M, Ruge MI, El Majdoub F, Treuer H, Mueller RP, Voges J, Sturm V (2012) LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results. Strahlenther Onkol 188(4):319–325CrossRefPubMedGoogle Scholar
  71. 71.
    Wilson PJ, De-Loyde KJ, Williams JR, Smee RI (2012) A single centre’s experience of stereotactic radiosurgery and radiotherapy for nonfunctioning pituitary adenomas with the linear accelerator (Linac). J Clin Neurosci 19(3):370–374CrossRefPubMedGoogle Scholar
  72. 72.
    Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG, Lunsford LD (2013) Gamma knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119(2):446–456CrossRefPubMedGoogle Scholar
  73. 73.
    Lee CC, Kano H, Yang HC, Xu Z, Yen CP, Chung WY, Pan DH, Lunsford LD, Sheehan JP (2014) Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas. J Neurosurg 120(3):647–654CrossRefPubMedGoogle Scholar
  74. 74.
    Bir SC, Murray RD, Ambekar S, Bollam P, Nanda A (2015) Clinical and radiologic outcome of gamma knife radiosurgery on nonfunctioning pituitary adenomas. J Neurol Surg B Skull Base 76(5):351–357CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59(2):244–254CrossRefPubMedGoogle Scholar
  76. 76.
    Puataweepong P, Dhanachai M, Hansasuta A, Dangprasert S, Swangsilpa T, Sitathanee C, Jiarpinitnun C, Vitoonpanich P, Yongvithisatid P (2016) The clinical outcome of hypofractionated stereotactic radiotherapy with cyberknife robotic radiosurgery for perioptic pituitary adenoma. Technol Cancer Res Treat 15(6):NP10-NP15CrossRefPubMedGoogle Scholar
  77. 77.
    Liao HI, Wang CC, Wei KC, Chang CN, Hsu YH, Lee ST, Huang YC, Chen HC, Hsu PW (2014) Fractionated stereotactic radiosurgery using the Novalis system for the management of pituitary adenomas close to the optic apparatus. J Clin Neurosci 2(1):111–115CrossRefGoogle Scholar
  78. 78.
    Milker-Zabel S, Debus J, Thilmann C, Schegel W, Wannenmacher M (2001) Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and non-functional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys 50(5):1279–1286CrossRefPubMedGoogle Scholar
  79. 79.
    Paek SH, Downes MB, Bednarz G, Keane WM, Werner-Wasik M, Curran WJ Jr, Andrews DW (2005) Integration of surgery with fractionated stereotactic radiotherapy for treatment of nonfunctioning pituitary macroadenomas. Int J Radiat Oncol Biol Phys 61(3):795–808CrossRefPubMedGoogle Scholar
  80. 80.
    Colin P, Jovenin N, Delemer B, Caron J, Grulet H, Hecart AC, Lukas C, Bazin A, Bernard MH, Scherpereel B, Peruzzi P, Nakib I, Redon C, Rousseaux P (2005) Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: a prospective study of 110 patients. Int J Radiat Oncol Biol Phys 62(2):333–341CrossRefPubMedGoogle Scholar
  81. 81.
    Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2006) Fractionated stereotactic conformal radiotherapy for secreting and nonsecreting pituitary adenomas. Clin Endocrinol 64(5):542–548CrossRefGoogle Scholar
  82. 82.
    Kong DS, Lee JI, Lim DH, Kim KW, Shin HJ, Nam DH, Park K, Kim JH (2007) The efficacy of fractionated radiotherapy and stereotactic radiosurgery for pituitary adenomas: long-term results of 125 consecutive patients treated in a single institution. Cancer 110(4):854–860CrossRefPubMedGoogle Scholar
  83. 83.
    Schalin-Jäntti C, Valanne L, Tenhunen M, Setälä K, Paetau A, Sane T, Kouri M (2010) Outcome of fractionated stereotactic radiotherapy in patients with pituitary adenomas resistant to conventional treatments: a 5.25-year follow-up study. Clin Endocrinol 73(1):72–77Google Scholar
  84. 84.
    Wilson PJ, De-Loyde KJ, Williams JR, Smee RI (2012) A single centre’s experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the linear accelerator (Linac). J Clin Neurosci 19(3):370–374CrossRefPubMedGoogle Scholar
  85. 85.
    Kopp C, Theodorou M, Poullos N, Astner ST, Geinitz H, Stalla GK, Meyer B, Molls M, Nieder C, Grosu AL (2013) Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas. Strahlenther Onkol 189(11):932–937CrossRefPubMedGoogle Scholar
  86. 86.
    Kim JO, Ma R, Akagami R, McKenzie M, Johnson M, Gete E, Nichol A (2013) Long-term outcomes of fractionated stereotactic radiation therapy for pituitary adenomas at the BC cancer agency. Int J Radiat Oncol Biol Phys 87(3):528–533CrossRefPubMedGoogle Scholar
  87. 87.
    Barber SM, Teh BS, Baskin DS (2016) Fractionated stereotactic radiotherapy for pituitary adenomas: single-center experience in 75 consecutive patients. Neurosurgery 79(3):406–417CrossRefPubMedGoogle Scholar
  88. 88.
    Minniti G, Scaringi C, Poggi M, Jaffrain Rea ML, Trillò G, Esposito V, Bozzao A, Enrici MM, Toscano V, Enrici RM (2015) Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response. Eur J Endocrinol 172(4):433–441CrossRefPubMedGoogle Scholar
  89. 89.
    Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol 134:521–535CrossRefPubMedGoogle Scholar
  90. 90.
    De Caro DB, Solari M, Pagliuca D, Villa F, Guadagno A, Cavallo E, Colao LM, Pettinato A, Cappabianca G P (2017) Atypical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients. Neurosurg Rev 40(1):105–114CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Giuseppe Minniti
    • 1
    • 2
  • John Flickinger
    • 3
  • Barbara Tolu
    • 1
  • Sergio Paolini
    • 2
  1. 1.UPMC San Pietro FBFRomeItaly
  2. 2.IRCCS NeuromedPozzilliItaly
  3. 3.Department of Radiation OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA

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