Radiotherapy for pituitary adenomas: Long-term efficacy and toxicity☆

Abstract 

Background

Radiotherapy for pituitary adenomas is an effective treatment but remains controversial due to toxicity concerns.

Materials and methods

A retrospective audit of patients referred for radiotherapy during 1974–2003 was conducted, the case records were examined and data linkage to cancer registry and hospital discharge records was performed to assess the overall survival (OS), progression-free survival (PFS) and late effects (hormone deficiency, reduced vision, second cancer and stroke).

Results

Three hundred and eighty-five patients had radiotherapy (median 45Gy). The OS was 74% and 49%, PFS was 97% and 96%, at 10 and 20years, respectively. No specific factors influenced local control. Additional hormone deficiencies occurred in 19% (ACTH) and 26% (TSH). Actuarial rate optic neuropathy at 10years was 0.8%. Seventy-eight patients had a stroke, a RR for a matched Scottish population of 1.45 (CI 1.05–1.18, p=0.03) men and 2.22 (1.56–3.08, p<0.01) women. Four intra-cranial tumours were identified; 20-year actuarial risk 1.9% (CI 0–2.6%), a RR of 5.65 (0.53–20.77, p=0.10) men and 9.94 (0.94–36.56, p=0.04) women.

Conclusions

This treatment is effective with good local control rates at 20years. A significant proportion developed hypo-pituitarism. The risk of optic neuropathy was low but risk of stroke increased, particularly in women who had slight increased risk of intra-cranial tumours.

Keywords: Pituitary adenoma, Radiotherapy, Toxicity, Second cancer, Cerebrovascular disease