Radiation techniques in aggressive pituitary tumours and carcinomas


Defining the role of radiation techniques in treatment of aggressive pituitary tumours and carcinomas is a difficult task: indeed, studies reported in the literature on this topic can probably be counted on the fingers of one hand. To try to better define these roles, it is thus necessary to extrapolate based on anti-secretory and anti-tumor efficacy reported in studies on non-selected pituitary tumours, regardless of their pathological status and intrinsic aggressiveness. Generally, radiation techniques are delivered as part of a multimodal treatment, usually with the primary aim of controlling tumor volume. Side-effects need to be divided into short and long-term, also depending on the overall prognosis of the tumour, since hypopituitarism will likely appear in the majority of patients, extra-pituitary side-effects, which have been reported after a significant delay after the procedure, can only be considered in patients with less aggressive pituitary tumours. In this review, we will first detail the different modalities of radiation techniques and the inherent limits of each technique depending on the volume and the localization of the tumour. We will then discuss the anti-tumour and anti-secretory efficacy of radiation techniques in aggressive pituitary tumors, either as a single treatment or as part of a multimodal treatment. Finally we will discuss the technique-specific side-effects.

This is a preview of subscription content, log in to check access.


  1. 1.

    Raverot G, Burman P, McCormack A, Heaney A, Petersenn S, Popovic V, et al. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol. 2018 Jan;178(1):G1–24.

    CAS  Article  Google Scholar 

  2. 2.

    McCormack A, Dekkers OM, Petersenn S, Popovic V, Trouillas J, Raverot G, et al. Treatment of aggressive pituitary tumours and carcinomas: results of a European Society of Endocrinology (ESE) survey 2016. Eur J Endocrinol. 2018;178(3):265–76.

    CAS  Article  Google Scholar 

  3. 3.

    Maione L, Brue T, Beckers A, Delemer B, Petrossians P, Borson-Chazot F, et al. Changes in the management and comorbidities of acromegaly over three decades: the French acromegaly registry. Eur J Endocrinol. 2017 May;176(5):645–55.

    CAS  Article  Google Scholar 

  4. 4.

    Vance ML. Pituitary radiotherapy. Endocrinol Metab Clin N Am. 2005 Jun;34(2):479–87 xi.

  5. 5.

    Minniti G, Gilbert DC, Brada M. Modern techniques for pituitary radiotherapy. Rev Endocr Metab Disord. 2009 Jun;10(2):135–44.

    CAS  Article  Google Scholar 

  6. 6.

    Minniti G, Flickinger J. The risk/benefit ratio of radiotherapy in pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019;16:101269.

    Article  Google Scholar 

  7. 7.

    Chanson P, Dormoy A, Dekkers O. Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas. Eur J Endocrinol. 2019 May;1.

  8. 8.

    Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, et al. Gamma knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg. 2013;119(2):446–56.

    Article  Google Scholar 

  9. 9.

    Gittoes NJ, Bates AS, Tse W, Bullivant B, Sheppard MC, Clayton RN, et al. Radiotherapy for non-function pituitary tumours. Clin Endocrinol. 1998;48(3):331–7.

    CAS  Article  Google Scholar 

  10. 10.

    Minniti G, Scaringi C, Poggi M, Jaffrain Rea ML, Trillò G, Esposito V, et al. 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. 2015;172(4):433–41.

    CAS  Article  Google Scholar 

  11. 11.

    Ogawa Y, Jokura H, Niizuma K, Tominaga T. Mid-term prognosis of non-functioning pituitary adenomas with high proliferative potential: really an aggressive variant? J Neuro-Oncol. 2018 May;137(3):543–9.

    Article  Google Scholar 

  12. 12.

    Pomeraniec IJ, Dallapiazza RF, Xu Z, Jane JA, Sheehan JP. Early versus late gamma knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study. J Neurosurg. 2016;125(1):202–12.

    CAS  Article  Google Scholar 

  13. 13.

    Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S, et al. Management of clinically non-functioning pituitary adenoma. Ann Endocrinol (Paris). 2015;76(3):239–47.

    Article  Google Scholar 

  14. 14.

    Raverot G, Dantony E, Beauvy J, Vasiljevic A, Mikolasek S, Borson-Chazot F, et al. Risk of Recurrence in Pituitary Neuroendocrine Tumors: A Prospective Study Using a Five-Tiered Classification. J Clin Endocrinol Metab. 2017;102(9):3368–74.

    Article  Google Scholar 

  15. 15.

    Verma J, McCutcheon IE, Waguespack SG, Mahajan A. Feasibility and outcome of re-irradiation in the treatment of multiply recurrent pituitary adenomas. Pituitary. 2014 Dec;17(6):539–45.

    CAS  Article  Google Scholar 

  16. 16.

    Castinetti F, Régis J, Dufour H, Brue T. Role of stereotactic radiosurgery in the management of pituitary adenomas. Nat Rev Endocrinol. 2010 Apr;6(4):214–23.

    Article  Google Scholar 

  17. 17.

    Ding D, Mehta GU, Patibandla MR, Lee C-C, Liscak R, Kano H, et al. Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study. Neurosurgery. 2019 Mar 1;84(3):717–25.

    Article  Google Scholar 

  18. 18.

    Mehta GU, Ding D, Patibandla MR, Kano H, Sisterson N, Su Y-H, et al. Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study. J Clin Endocrinol Metab. 2017;102(11):4284–91.

    Article  Google Scholar 

  19. 19.

    Hung Y-C, Lee C-C, Yang H-C, Mohammed N, Kearns KN, Nabeel AM, et al. The benefit and risk of stereotactic radiosurgery for prolactinomas: an international multicenter cohort study. J Neurosurg. 2019 Aug;2:1–10.

    Google Scholar 

  20. 20.

    Shimon I, Jallad RS, Fleseriu M, Yedinak CG, Greenman Y, Bronstein MD. Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors. Eur J Endocrinol. 2015;172(6):707–13.

    CAS  Article  Google Scholar 

  21. 21.

    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.

    CAS  Article  Google Scholar 

  22. 22.

    Kil WJ, Cerna D, Burgan WE, Beam K, Carter D, Steeg PS, et al. In vitro and in vivo radiosensitization induced by the DNA methylating agent temozolomide. Clin Cancer Res. 2008;14(3):931–8.

    CAS  Article  Google Scholar 

  23. 23.

    Carlson BL, Grogan PT, Mladek AC, Schroeder MA, Kitange GJ, Decker PA, et al. Radiosensitizing effects of temozolomide observed in vivo only in a subset of O6-methylguanine-DNA methyltransferase methylated glioblastoma multiforme xenografts. Int J Radiat Oncol Biol Phys. 2009;75(1):212–9.

    CAS  Article  Google Scholar 

  24. 24.

    Ilie MD, Lasolle H, Raverot G. Emerging and novel treatments for pituitary tumors. J Clin Med. 2019;25:8(8).

    Google Scholar 

  25. 25.

    Touma W, Hoostal S, Peterson RA, Wiernik A, SantaCruz KS, Lou E. Successful treatment of pituitary carcinoma with concurrent radiation, temozolomide, and bevacizumab after resection. J Clin Neurosci. 2017;41:75–7.

    CAS  Article  Google Scholar 

  26. 26.

    Dutta P, Reddy KS, Rai A, Madugundu AK, Solanki HS, Bhansali A, et al. Surgery, Octreotide, Temozolomide, Bevacizumab, radiotherapy, and Pegvisomant treatment of an AIP mutation–positive child. J Clin Endocrinol Metab. 2019;104(8):3539–44.

    Article  Google Scholar 

  27. 27.

    Cordeiro D, Xu Z, Mehta G, Ding D, Vance ML, Kano H, et al. Hypopituitarism after gamma knife radiosurgery for pituitary adenomas: a multicenter, international study. J Neurosurg. 2018;09.

  28. 28.

    Burman P, van Beek AP, Biller BMK, Camacho-Hübner C, Mattsson AF. Radiotherapy, especially at Young age, increases the risk for De novo brain tumors in patients treated for pituitary/Sellar lesions. J Clin Endocrinol Metab. 2017;102(3):1051–8.

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Frederic Castinetti.

Ethics declarations

Conflict of interest

The author has nothing to disclose.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Castinetti, F. Radiation techniques in aggressive pituitary tumours and carcinomas. Rev Endocr Metab Disord 21, 287–292 (2020). https://doi.org/10.1007/s11154-020-09543-y

Download citation


  • Pituitary
  • Carcinoma
  • Acromegaly
  • Cushing’s disease
  • Prolactinoma
  • Non-functioning pituitary tumors
  • Gamma knife
  • Radiotherapy
  • Fractionated stereotactic radiotherapy
  • Temozolomide
  • Bevacizumab