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Pituitary and Pituitary Region Tumors: Viewpoint—Fractionated Radiation Therapy

  • Chapter
Principles and Practice of Stereotactic Radiosurgery

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Abstract

Pituitary region tumors, including functional and nonfunctional pituitary adenomas, meningiomas, and craniopharyngiomas, are important and distinct benign entities that have both distinct and shared management issues. It is important to have multidisciplinary management to achieve optimal outcomes for patients with pituitary region tumors. These patients may enjoy normal or near-normal life spans but may have lifelong tumor-related or iatrogenic morbidity that can include visual problems (visual field cuts and gaze palsies), endocrine insufficiencies that require monitoring and replacement, and neurocognitive deficits that impair important capabilities and quality of life.

Because surgical management and medical management may not suffice to prevent morbidity from tumor growth or hormonal secretion, irradiation is an option that must be considered as part of multidisciplinary management. For tumors in this region, fractionated radiation therapy has a long and successful track record in controlling tumor growth and may often be a better choice than radiosurgery.

Radiotherapy’s small daily doses exploit the radiobiological advantages of reoxygenation, redistribution, and repair of DNA damage (which increases the dose that can be given to normal tissues). As most tumors in this location are slow-growing, benign tumors, repopulation of the tumor being irradiated during a course of radiotherapy treatment is not a concern.

Current focused radiation therapy approaches using image guidance and attempting to spare normal tissues such as the hippocampi may result in an improved risk-benefit ratio for patients. Randomized clinical trials to document improved outcomes for patients treated with these advanced technologies or alternative approaches such as proton beam therapy are lacking, as are trials comparing radiosurgery and fractionated radiotherapy.

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References

  1. Rhoton Jr AL. The anterior and middle cranial base. Neurosurgery. 2002;51:S273–302.

    PubMed  Google Scholar 

  2. Laws Jr ER, Thapar K. Brain tumors. CA Cancer J Clin. 1993;43:263–71.

    Article  PubMed  Google Scholar 

  3. Costello RT. Subclinical adenoma of the pituitary gland. Am J Pathol. 1936;12:205–16.

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Kernohan JW, Sayre GP. Tumors of the pituitary gland and infundibulum. In: Atlas of tumor pathology. Washington: Armed Forces Institute of Pathology, Section X, Fascicle 36; 1956.

    Google Scholar 

  5. DeMonte F, Al-Mefty O. Meningiomas. In: Kaye AH, Laws ER, editors. Brain tumors. New York: Churchill Livingstone; 1995. p. 675–704.

    Google Scholar 

  6. Moss J, DeCastro R, Patronas NJ, et al. Meningiomas in lymphangioleiomyomatosis. JAMA. 2001;286:1879–81.

    Article  CAS  PubMed  Google Scholar 

  7. Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK editors. WHO classification of tumours of the central nervous system. 4th ed. Lyon: The International Agency for Research on Cancer; 2007. p. 164–72.

    Google Scholar 

  8. Perry A, Stafford SL, Scheithauer BW, et al. Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol. 1997;21:1455–65.

    Article  CAS  PubMed  Google Scholar 

  9. Perry A, Scheithauer BW, Stafford SL, et al. “Malignancy” in meningiomas: a clinicopathologic study of 116 patients. Cancer. 1999;85:2046–56.

    CAS  PubMed  Google Scholar 

  10. Kahn EA, Gosch HH, Seeger JF, et al. Forty-five years experience with the craniopharyngiomas. Surg Neurol. 1973;1:5–12.

    CAS  PubMed  Google Scholar 

  11. Yasargil MG, Curcic M, Kis M, et al. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg. 1990;73:3–11.

    Article  CAS  PubMed  Google Scholar 

  12. Adamson TE, Wiestler OD, Kleihues P, et al. Correlation of clinical and pathological features in surgically treated craniopharyngiomas. J Neurosurg. 1990;73:12–7.

    Article  CAS  PubMed  Google Scholar 

  13. Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg. 1969;16:185–217.

    CAS  PubMed  Google Scholar 

  14. Leavens ME, McCutcheon IF, Samaan NA. Management of pituitary adenomas. Oncology (Williston Park). 1992;6(6):69–79; discussion 79–80.

    CAS  Google Scholar 

  15. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20:22–39.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Tsang RW, Brierley JD, Panzarella T, et al. Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 1994;30:557–65.

    Article  CAS  PubMed  Google Scholar 

  17. Perry A, Gutmann DH, Reifenberger G. Molecular pathogenesis of meningiomas. J Neurooncol. 2004;70:183–202.

    Article  PubMed  Google Scholar 

  18. Perry A. Unmasking the secrets of meningioma: a slow but rewarding journey. Surg Neurol. 2004;61:171–3.

    Article  PubMed  Google Scholar 

  19. Molitch ME. Medical management of prolactin-secreting pituitary adenomas. Pituitary. 2002;5:55–65.

    Article  CAS  PubMed  Google Scholar 

  20. Racine MS, Barkan AL. Medical management of growth hormone-secreting pituitary adenomas. Pituitary. 2002;5:67–76.

    Article  CAS  PubMed  Google Scholar 

  21. Beck-Peccoz P, Persani L. Medical management of thyrotropin-secreting pituitary adenomas. Pituitary. 2002;5:83–8.

    Article  CAS  PubMed  Google Scholar 

  22. Tishler RB, Loeffler JS, Lunsford LD, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys. 1993;27:215–21.

    Article  CAS  PubMed  Google Scholar 

  23. Leber KA, Bergloff J, Pendl G. Dose–response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg. 1998;88:43–50.

    Article  CAS  PubMed  Google Scholar 

  24. Stafford SL, Pollock BE, Leavitt JA, et al. A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2003;55:1177–81.

    Article  PubMed  Google Scholar 

  25. van den Bergh AC, Schoorl MA, Dullaart RP, et al. Lack of radiation optic neuropathy in 72 patients treated for pituitary adenoma. J Neuroophthalmol. 2004;24:200–5.

    Article  PubMed  Google Scholar 

  26. al-Mefty O, Kersh JE, Routh A, et al. The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg. 1990;73:502–12.

    Article  CAS  PubMed  Google Scholar 

  27. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56:83–8.

    Article  PubMed  Google Scholar 

  28. Ohtakara K, Hayashi S, Tanaka H, et al. Clinical comparison of positional accuracy and stability between dedicated versus conventional masks for immobilization in cranial stereotactic radiotherapy using 6-degree-of-freedom image guidance system-integrated platform. Radiother Oncol. 2012;102:198–205.

    Article  PubMed  Google Scholar 

  29. Marks JE, Baglan RJ, Prassad SC, et al. Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys. 1981;7:243–52.

    Article  CAS  PubMed  Google Scholar 

  30. Goldsmith BJ, Larson DA. Conventional radiation therapy for skull base meningiomas. Neurosurg Clin N Am. 2000;11:605–15.

    CAS  PubMed  Google Scholar 

  31. Graham JD, Nahum AE, Brada M. A comparison of techniques for stereotactic radiotherapy by linear accelerator based on 3-dimensional dose distributions. Radiother Oncol. 1991;22:29–35.

    Article  CAS  PubMed  Google Scholar 

  32. Perks JR, Jalali R, Cosgrove VP, et al. Optimization of stereotactically-guided conformal treatment planning of sellar and parasellar tumors, based on normal brain dose volume histograms. Int J Radiat Oncol Biol Phys. 1999;45:507–13.

    Article  CAS  PubMed  Google Scholar 

  33. Taylor BF, Picone J, Kimmett J, et al. Improved hippocampal-sparing using an asymmetric conformal arc technique for treatment of pituitary lesions. Int J Radiat Oncol Biol Phys. 2011;81(Suppl):S291–2.

    Article  Google Scholar 

  34. Kondziolka D, Lunsford LD, Loeffler JS, et al. Radiosurgery and radiotherapy: observations and clarifications. J Neurosurg. 2004;101:585–9.

    Article  PubMed  Google Scholar 

  35. Boehling NS, Grosshans DR, Bluett JB, et al. Dosimetric comparison of three-dimensional conformal proton radiotherapy, intensity-modulated proton therapy, and intensity-modulated radiotherapy for treatment of pediatric craniopharyngiomas. Int J Radiat Oncol Biol Phys. 2012;82:643–52.

    Article  PubMed  Google Scholar 

  36. Arvold ND, Niemierko A, Broussard GP, et al. Projected second tumor risk and dose to neurocognitive structures after proton versus photon radiotherapy for benign meningioma. Int J Radiat Oncol Biol Phys. 2012;83(4):e495–500.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  CAS  Google Scholar 

  38. Tsang RW, Brierley JD, Panzarella T, et al. Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol. 1996;41:45–53.

    Article  CAS  PubMed  Google Scholar 

  39. McCord MW, Buatti JM, Fennell EM, et al. Radiotherapy for pituitary adenoma: long-term outcome and sequelae. Int J Radiat Oncol Biol Phys. 1997;39:437–44.

    Article  CAS  PubMed  Google Scholar 

  40. Zierhut D, Flentje M, Adolph J, et al. External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1995;33:307–14.

    Article  CAS  PubMed  Google Scholar 

  41. Milker-Zabel S, Debus J, Thilmann C, et al. Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys. 2001;50:1279–86.

    Article  CAS  PubMed  Google Scholar 

  42. Grabenbauer GG, Fietkau R, Buchfelder M, et al. Hormonally inactive hypophyseal adenomas: the results and late sequelae after surgery and radiotherapy. Strahlenther Onkol. 1996;172:193–7.

    CAS  PubMed  Google Scholar 

  43. Woollons AC, Hunn MK, Rajapakse YR, et al. Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf). 2000;53:713–7.

    Article  CAS  Google Scholar 

  44. Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, et al. Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery. 1998;43:432–8.

    Article  CAS  PubMed  Google Scholar 

  45. Greenman Y, Ouaknine G, Veshchev I, et al. Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf). 2003;58:763–9.

    Article  CAS  Google Scholar 

  46. Grigsby PW, Simpson JR, Fineberg B. Late regrowth of pituitary adenomas after irradiation and/or surgery. Hazard function analysis. Cancer. 1989;63:1308–12.

    Article  CAS  PubMed  Google Scholar 

  47. Breen P, Flickinger JC, Kondziolka D, et al. Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control. J Neurosurg. 1998;89:933–8.

    Article  CAS  PubMed  Google Scholar 

  48. Chen Y, Wang CD, Su ZP, et al. Natural history of postoperative nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Neuroendocrinology. 2012;96(4):333–42.

    Article  CAS  PubMed  Google Scholar 

  49. Park P, Chandler WF, Barkan AL, et al. The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery. 2004;55:100–6.

    Article  PubMed  Google Scholar 

  50. van den Bergh AC, Hoving MA, Links TP, et al. Radiation optic neuropathy after external beam radiation therapy for acromegaly: report of two cases. Radiother Oncol. 2003;68:101–3.

    Article  PubMed  Google Scholar 

  51. Goffman TE, Dewan R, Arakaki R, et al. Persistent or recurrent acromegaly. Long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy. Cancer. 1992;69:271–5.

    Article  CAS  PubMed  Google Scholar 

  52. Grigsby PW, Stokes S, Marks JE, et al. Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1988;15:1103–10.

    Article  CAS  PubMed  Google Scholar 

  53. Gittoes NJ, Bates AS, Tse W, et al. Radiotherapy for non-function pituitary tumours. Clin Endocrinol (Oxf). 1998;48:331–7.

    Article  CAS  Google Scholar 

  54. Sasaki R, Murakami M, Okamoto Y, et al. The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys. 2000;47:1337–45.

    Article  CAS  PubMed  Google Scholar 

  55. Dowsett RJ, Fowble B, Sergott RC, et al. Results of radiotherapy in the treatment of acromegaly: lack of ophthalmologic complications. Int J Radiat Oncol Biol Phys. 1990;19:453–9.

    Article  CAS  PubMed  Google Scholar 

  56. Giustina A, Chanson P, Bronstein MD, et al. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab. 2010;95:3141–8.

    Article  CAS  PubMed  Google Scholar 

  57. Gullu S, Keles H, Delibasi T, et al. Remission criteria for the follow-up of patients with acromegaly. Eur J Endocrinol. 2004;150:465–71.

    Article  CAS  PubMed  Google Scholar 

  58. Giustina A, Bronstein MD, Casanueva FF. Current management practices for acromegaly: an international survey. Pituitary. 2011;14:125–33.

    Article  CAS  PubMed  Google Scholar 

  59. Melmed S, Sternberg R, Cook D, et al. A critical analysis of pituitary tumor shrinkage during primary medical therapy in acromegaly. J Clin Endocrinol Metab. 2005;90:4405–10.

    Article  CAS  PubMed  Google Scholar 

  60. Landolt AM, Haller D, Lomax N, et al. Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab. 2000;85:1287–9.

    Article  CAS  PubMed  Google Scholar 

  61. Roug S, Rasmussen AK, Juhler M, et al. Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit. Eur J Endocrinol. 2010;162:685–94.

    Article  CAS  PubMed  Google Scholar 

  62. Eastman RC, Gorden P, Glatstein E, et al. Radiation therapy of acromegaly. Endocrinol Metab Clin North Am. 1992;21:693–712.

    CAS  PubMed  Google Scholar 

  63. Minniti G, Jaffrain-Rea ML, Osti M, et al. The long-term efficacy of conventional radiotherapy in patients with GH-secreting pituitary adenomas. Clin Endocrinol (Oxf). 2005;62:210–6.

    Article  Google Scholar 

  64. Biermasz NR, van Dulken H, Roelfsema F. Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. J Clin Endocrinol Metab. 2000;85:2476–82.

    Article  CAS  PubMed  Google Scholar 

  65. Thalassinos NC, Tsagarakis S, Ioannides G, et al. Megavoltage pituitary irradiation lowers but seldom leads to safe GH levels in acromegaly; a long-term follow-up study. Eur J Endocrinol. 1998;138:160–3.

    Article  CAS  PubMed  Google Scholar 

  66. Milker-Zabel S, Zabel A, Huber P, et al. Stereotactic conformal radiotherapy in patients with growth hormone-secreting pituitary adenoma. Int J Radiat Oncol Biol Phys. 2004;59:1088–96.

    Article  PubMed  Google Scholar 

  67. González B, Vargas G, Espinosa-de-los-Monteros AL, et al. Efficacy and safety of radiotherapy in acromegaly. Arch Med Res. 2011;42:48–52.

    Article  PubMed  Google Scholar 

  68. Williams M, van Seters AP, Hermans J, et al. Evaluation of the effects of radiotherapy on macroprolactinomas using the decline rate of serum prolactin levels as a dynamic parameter. Clin Oncol (R Coll Radiol). 1994;6:102–9.

    Article  CAS  Google Scholar 

  69. Ozgen T, Oruckaptan HH, Ozcan OE, et al. Prolactin secreting pituitary adenomas: analysis of 429 surgically treated patients, effect of adjuvant treatment modalities and review of the literature. Acta Neurochir (Wien). 1999;141:1287–94.

    Article  CAS  Google Scholar 

  70. Littley MD, Shalet SM, Reid H, et al. The effect of external pituitary irradiation on elevated serum prolactin levels in patients with pituitary macroadenomas. Q J Med. 1991;81:985–98.

    Article  CAS  PubMed  Google Scholar 

  71. Wallace EA, Holdaway IM. Treatment of macroprolactinomas at Auckland Hospital 1975–91. N Z Med J. 1995;108:50–2.

    CAS  PubMed  Google Scholar 

  72. Tsagarakis S, Grossman A, Plowman PN, et al. Megavoltage pituitary irradiation in the management of prolactinomas: long-term follow-up. Clin Endocrinol (Oxf). 1991;34:399–406.

    Article  CAS  Google Scholar 

  73. Sun DQ, Cheng JJ, Frazier JL, Batra S, Wand G, Kleinberg LR, et al. Treatment of pituitary adenomas using radiosurgery and radiotherapy: a single center experience and review of literature. Neurosurg Rev. 2011;34:181–9.

    Article  Google Scholar 

  74. Vicente A, Estrada J, de la Cuerda C, et al. Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. Acta Endocrinol (Copenh). 1991;125:470–4.

    CAS  Google Scholar 

  75. Plowman PN. Pituitary adenoma radiotherapy—when, who and how? Clin Endocrinol (Oxf). 1999;51:265–71.

    Article  CAS  Google Scholar 

  76. Becker G, Kocher M, Kortmann RD, et al. Radiation therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol. 2002;178:173–86.

    Article  PubMed  Google Scholar 

  77. Mahmoud-Ahmed AS, Suh JH. Radiation therapy for Cushing’s disease: a review. Pituitary. 2002;5:175–80.

    Article  CAS  PubMed  Google Scholar 

  78. Melby JC. Therapy of Cushing [sic] disease: a consensus for pituitary microsurgery. Ann Intern Med. 1988;109:445–6.

    Article  CAS  PubMed  Google Scholar 

  79. Mampalam TJ, Tyrrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing [sic)] disease. A report of 216 cases. Ann Intern Med. 1988;109:487–93.

    Article  CAS  PubMed  Google Scholar 

  80. Howlett TA, Plowman PN, Wass JA, et al. Megavoltage pituitary irradiation in the management of Cushing’s disease and Nelson’s syndrome: long-term follow-up. Clin Endocrinol (Oxf). 1989;31:309–23.

    Article  CAS  Google Scholar 

  81. Nagesser SK, van Seters AP, Kievit J, et al. Treatment of pituitary-dependent Cushing’s syndrome: long-term results of unilateral adrenalectomy followed by external pituitary irradiation compared to transsphenoidal pituitary surgery. Clin Endocrinol (Oxf). 2000;52:427–35.

    Article  CAS  Google Scholar 

  82. Miller JW, Crapo L. The medical treatment of Cushing’s syndrome. Endocr Rev. 1993;14:443–58.

    Article  CAS  PubMed  Google Scholar 

  83. Estrada J, Boronat M, Mielgo M, et al. The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med. 1997;336:172–7.

    Article  CAS  PubMed  Google Scholar 

  84. Selch MT, Ahn E, Laskari A, Lee SP, et al. Stereotactic radiotherapy for treatment of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys. 2004;59:101–11.

    Article  PubMed  Google Scholar 

  85. Dufour H, Muracciole X, Metellus P, et al. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal? Neurosurgery. 2001;48:285–94.

    CAS  PubMed  Google Scholar 

  86. Milker-Zabel S, Zabel A, Schulz-Ertner D, et al. Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors. Int J Radiat Oncol Biol Phys. 2005;61:809–16.

    Article  PubMed  Google Scholar 

  87. Jalali R, Loughrey C, Baumert B, et al. High precision focused irradiation in the form of fractionated stereotactic conformal radiotherapy (SCRT) for benign meningiomas predominantly in the skull base location. Clin Oncol (R Coll Radiol). 2002;14:103–9.

    Article  CAS  Google Scholar 

  88. Debus J, Wuendrich M, Pirzkall A, et al. High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. J Clin Oncol. 2001;19:3547–53.

    CAS  PubMed  Google Scholar 

  89. Uy NW, Woo SY, Teh BS, et al. Intensity-modulated radiation therapy (IMRT) for meningioma. Int J Radiat Oncol Biol Phys. 2002;53:1265–70.

    Article  PubMed  Google Scholar 

  90. Hetelekidis S, Barnes PD, Tao ML, et al. 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys. 1993;27(2):189–95.

    Article  CAS  PubMed  Google Scholar 

  91. Kalapurakal JA. Radiation therapy in the management of pediatric craniopharyngiomas—a review. Childs Nerv Syst. 2005;21(8–9):808–16.

    Article  PubMed  Google Scholar 

  92. Schoenfeld A, Pekmezci M, Barnes MJ, et al. The superiority of conservative resection and adjuvant radiation for craniopharyngiomas. J Neurooncol. 2012;108:133–9.

    Article  PubMed  Google Scholar 

  93. Hasegawa T, Kondziolka D, Hadjipanayis CG, et al. Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery. 2004;54:813–20.

    Article  PubMed  Google Scholar 

  94. Glod J, Koch B, Myseros J, Breneman J, et al. Issues concerning the treatment of a child with a craniopharyngioma. Med Pediatr Oncol. 2002;38:360–7.

    Article  PubMed  Google Scholar 

  95. Freeman CR, Patrocinio H, Farmer JP. Highly conformal radiotherapy for craniopharyngioma: (potentially) throwing the baby out with the bathwater. Med Pediatr Oncol. 2003;40:340–1.

    Article  PubMed  Google Scholar 

  96. Selch MT, DeSalles AA, Wade M, et al. Initial clinical results of stereotactic radiotherapy for the treatment of craniopharyngiomas. Technol Cancer Res Treat. 2002;1:51–9.

    Article  PubMed  Google Scholar 

  97. Combs SE, Thilmann C, Huber PE, et al. Achievement of long-term local control in patients with craniopharyngiomas using high precision stereotactic radiotherapy. Cancer. 2007;109:2308–14.

    Article  PubMed  Google Scholar 

  98. Minniti G, Saran F, Traish D, et al. Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas. Radiother Oncol. 2007;82:90–5.

    Article  PubMed  Google Scholar 

  99. Smee RI, Williams JR, Kwok B, et al. Modern radiotherapy approaches in the management of craniopharyngiomas. J Clin Neurosci. 2011;18:613–7.

    Article  PubMed  Google Scholar 

  100. Masson-Cote L, Masucci GL, Atenafu EG, et al. Long-term outcomes for adult craniopharyngioma following radiation therapy. Acta Oncol. 2013;52(1):153–8.

    Article  PubMed  Google Scholar 

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  1. Department of Radiation Medicine, North Shore LIJ Health System, Hofstra North Shore LIJ School of Medicine, 300 Community Drive, Manhasset, NY, 11030, USA

    Jonathan P. S. Knisely M.D.

  2. Minneapolis Radiation Oncology & Gamma Knife Center, University of Minnesota, 560 South Maple Street, Suite 10, Waconia, MN, 55391, USA

    Paul W. Sperduto M.D., M.P.P., F.A.S.T.R.O.

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  1. Jonathan P. S. Knisely M.D.
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Correspondence to Paul W. Sperduto M.D., M.P.P., F.A.S.T.R.O. .

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Editors and Affiliations

  1. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, USA

    Lawrence S. Chin

  2. Dept. of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, Maryland, USA

    William F. Regine

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Knisely, J.P.S., Sperduto, P.W. (2015). Pituitary and Pituitary Region Tumors: Viewpoint—Fractionated Radiation Therapy. In: Chin, L., Regine, W. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8363-2_28

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