title: Fractionated proton beam irradiation of pituitary adenomas.
abstract: OBJECTIVE
  Various radiation techniques and modalities have been used to treat pituitary adenomas. This report details our experience with proton treatment of these tumors.
  
  
  METHODS
  Forty-seven patients with pituitary adenomas treated with protons, who had at least 6 months of follow-up, were included in this analysis. Forty-two patients underwent a prior surgical resection; 5 were treated with primary radiation. Approximately half the tumors were functional. The median dose was 54 cobalt-gray equivalent.
  
  
  RESULTS
  Tumor stabilization occurred in all 41 patients available for follow-up imaging; 10 patients had no residual tumor, and 3 had greater than 50% reduction in tumor size. Seventeen patients with functional adenomas had normalized or decreased hormone levels; progression occurred in 3 patients. Six patients have died; 2 deaths were attributed to functional progression. Complications included temporal lobe necrosis in 1 patient, new significant visual deficits in 3 patients, and incident hypopituitarism in 11 patients.
  
  
  CONCLUSIONS
  Fractionated conformal proton-beam irradiation achieved effective radiologic, endocrinological, and symptomatic control of pituitary adenomas. Significant morbidity was uncommon, with the exception of postradiation hypopituitarism, which we attribute in part to concomitant risk factors for hypopituitarism present in our patient population.
authors.affiliation: Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ronson
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Schulte
authors.forename: Khanh P
authors.initials: KP
authors.lastname: Han
authors.forename: Lilia N
authors.initials: LN
authors.lastname: Loredo
authors.forename: James M
authors.initials: JM
authors.lastname: Slater
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Slater
mesh_terms: D000236:Adenoma / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy*; D061766:Proton Therapy; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D013972:Thyrotropin / Q000378:metabolism
chemical_list: D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin