Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: beneficial effect on local control without additional negative impact on pituitary function and life expectancy.
OBJECTIVE
To demonstrate the benefit of immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma (NFA) in perspective to the need for hormonal substitution and life expectancy.


METHODS
Retrospective cohort analysis of 122 patients, operated for NFA between 1979 and 1998. Recurrence was defined as regrowth on computed tomography or magnetic resonance imaging. The occurrence of hormonal deficiencies was defined as the starting date of hormonal substitution therapy.


RESULTS
Seventy-six patients had residual NFA after surgery and received immediate postoperative radiotherapy (Group 1); three patients developed a recurrence, resulting in a 95% local control rate at 10 years. Twenty-eight patients had residual NFA after surgery, but were followed by a wait-and-see policy (Group 2). Sixteen developed a recurrence, resulting in a local control rate of 49% at 5 years and 22% at 10 years (p < 0.001 compared with Group 1). There were no differences between Group 1 and 2 regarding the need for substitution with thyroid hormone, glucocorticoids, and sex hormones before first surgery, directly after surgery and at end of follow-up. There were no differences in hormone substitution free survival between Group 1 and Group 2 during the study period after first surgery. Life expectancy was similar in Group 1 and 2, and their median life expectancy did not differ from median life expectancy in the general population.


CONCLUSIONS
Immediate postoperative radiotherapy provides a marked improvement of local control among patients with residual NFA compared with surgery alone, without an additional deleterious effect on pituitary function and life expectancy.
van den Bergh
Alfons C M
AC
Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands. a.c.m.van.den.bergh@rt.umcg.nl
van den Berg
Gerrit
G
Schoorl
Michiel A
MA
Sluiter
Wim J
WJ
van der Vliet
Anton M
AM
Hoving
Eelco W
EW
Szabó
Ben G
BG
Langendijk
Johannes A
JA
Wolffenbuttel
Bruce H R
BH
Dullaart
Robin P F
RP
D000236:Adenoma / Q000532:radiotherapy* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010902:Pituitary Gland / Q000502:physiology / Q000528:radiation effects*; D010911:Pituitary Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy