Radiotherapy for pituitary adenomas: long-term outcome and complications.
10.3857/roj.2011.29.3.156
- Author:
Chai Hong RIM
1
;
Dae Sik YANG
;
Young Je PARK
;
Won Sup YOON
;
Jung Ae LEE
;
Chul Yong KIM
Author Information
1. Department of Radiation Oncology, Korea University Medical Center, Seoul, Korea. kcyro@korea.ac.kr
- Publication Type:Original Article
- Keywords:
Pituitary adenoma;
Radiotherapy;
Prognostic factors;
Complications
- MeSH:
Academic Medical Centers;
Acromegaly;
Adenoma;
Amenorrhea;
Cavernous Sinus;
Cranial Nerves;
Dementia;
Dizziness;
Female;
Follow-Up Studies;
Galactorrhea;
Gynecomastia;
Headache;
Humans;
Hypopituitarism;
Korea;
Libido;
Magnetic Resonance Imaging;
Male;
Medical Records;
Menstruation;
Multivariate Analysis;
Pituitary Neoplasms;
Pregnancy;
Protons;
Radiosurgery;
Recurrence;
Retrospective Studies;
Stroke;
Unconsciousness;
Vision Disorders
- From:Radiation Oncology Journal
2011;29(3):156-163
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. RESULTS: Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. CONCLUSION: EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.
