Fractionated proton beam irradiation of pituitary adenomas.
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.
Ronson
Brian B
BB
Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Schulte
Reinhard W
RW
Han
Khanh P
KP
Loredo
Lilia N
LN
Slater
James M
JM
Slater
Jerry D
JD
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
D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin