title: Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: a prospective study of 110 patients.
abstract: OBJECTIVE
  To optimize and reduce the toxicity of pituitary adenoma irradiation by assessing the feasibility and effectiveness of fractionated stereotactic radiotherapy (FSR).
  
  
  METHODS
  Between 1990 and 1999, 110 consecutive patients, 47 with a functioning adenoma, were treated according to a strategy of either early surgery and FSR (n = 89) or FSR only (n = 21). Of the 110 patients, 75 had persistent macroscopic tumor and 47 persistent hormonal secretions; 15 were treated in the prophylactic setting. The linear accelerator-delivered dose was 50.4 Gy (5 x 1.8 Gy weekly), with a 2-mm safety margin.
  
  
  RESULTS
  After a minimal follow-up of 48 months, only 1 patient had developed progression. Of the 110 patients, 27 (36%) had a complete tumor response, 67 (89.3%) had an objective tumor response, 20 (42%) had a hormonal complete response, and 47 (100%) had a hormonal objective tumor response. The proportion of patients without a complete tumor response, objective tumor response, complete hormonal response, and objective hormonal response was 85.1%, 62%, 83%, and 59.3% at 4 years and 49.3%, 9%, 59.3%, and 10.6% at 8 years, respectively. The sole unfavorable predictive factor was preoperative SSE >20 mm for tumor response (p = 0.01) and growth hormone adenoma for the hormonal response (p <0.001). No late complications, except for pituitary deficiency, were reported, with a probability of requiring hormonal replacement of 28.5% and 35% at 4 and 8 years, respectively. Nonfunctioning status was the sole unfavorable factor (p = 0.0016).
  
  
  CONCLUSIONS
  Surgery plus FSR is safe and effective. FSR focused to the target volume seems more suitable than standard radiotherapy, and standard fractionation reduces the risk of optic neuropathy sometimes observed after single-dose radiosurgery. Therefore, FSR allows us to consider combined transrhinoseptal surgery and early radiotherapy, with a curative goal without patient selection.
authors.affiliation: Department of Radiation, Polyclinique Courlancy, Reims, France; Department of Neurosurgery, Centre Hospitalier Universitaire Reims, Reims, France. courlancy.colin@wanadoo.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Colin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jovenin
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delemer
authors.forename: Jean
authors.initials: J
authors.lastname: Caron
authors.forename: Herve
authors.initials: H
authors.lastname: Grulet
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Hecart
authors.forename: Celine
authors.initials: C
authors.lastname: Lukas
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bazin
authors.forename: Mary-Helene
authors.initials: MH
authors.lastname: Bernard
authors.forename: Bernard
authors.initials: B
authors.lastname: Scherpereel
authors.forename: Philippe
authors.initials: P
authors.lastname: Peruzzi
authors.forename: Iab
authors.initials: I
authors.lastname: Nakib
authors.forename: Charles
authors.initials: C
authors.lastname: Redon
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousseaux
mesh_terms: D000236:Adenoma / Q000378:metabolism / Q000601:surgery*; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D011388:Prolactin / Q000378:metabolism; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D014786:Vision Disorders / Q000601:surgery; D014792:Visual Acuity
chemical_list: D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D013006:Growth Hormone