Radiotherapy for pituitary adenomas: long-term efficacy and toxicity.
BACKGROUND
Radiotherapy for pituitary adenomas is an effective treatment but remains controversial due to toxicity concerns.


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 45 Gy). The OS was 74% and 49%, PFS was 97% and 96%, at 10 and 20 years, respectively. No specific factors influenced local control. Additional hormone deficiencies occurred in 19% (ACTH) and 26% (TSH). Actuarial rate optic neuropathy at 10 years 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 20 years. 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.
Erridge
Sara C
SC
Edinburgh Centre for Neuro-Oncology, University of Edinburgh, UK. serridge@staffmail.ed.ac.uk
Conkey
David S
DS
Stockton
Diane
D
Strachan
Mark W J
MW
Statham
Patrick F X
PF
Whittle
Ian R
IR
Grant
Robin
R
Kerr
Gillian R
GR
Gregor
Anna
A
D000236:Adenoma / Q000150:complications / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary; D010911:Pituitary Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries; D015996:Survival Rate; D055815:Young Adult