title: Long-term outcomes of fractionated stereotactic radiation therapy for pituitary adenomas at the BC Cancer Agency.
abstract: OBJECTIVE
  To assess the long-term disease control and toxicity outcomes of fractionated stereotactic radiation therapy (FSRT) in patients with pituitary adenomas treated at the BC Cancer Agency.
  
  
  METHODS
  To ensure a minimum of 5 years of clinical follow-up, this study identified a cohort of 76 patients treated consecutively with FSRT between 1998 and 2007 for pituitary adenomas: 71% (54/76) had nonfunctioning and 29% (22/76) had functioning adenomas (15 adrenocorticotrophic hormone-secreting, 5 growth hormone-secreting, and 2 prolactin-secreting). Surgery was used before FSRT in 96% (73/76) of patients. A median isocenter dose of 50.4 Gy was delivered in 28 fractions, with 100% of the planning target volume covered by the 90% isodose. Patients were followed up clinically by endocrinologists, ophthalmologists, and radiation oncologists. Serial magnetic resonance imaging was used to assess tumor response.
  
  
  RESULTS
  With a median follow-up time of 6.8 years (range, 0.6 - 13.1 years), the 7-year progression-free survival was 97.1% and disease-specific survival was 100%. Of the 2 patients with tumor progression, both had disease control after salvage surgery. Of the 22 patients with functioning adenomas, 50% (11/22) had complete and 9% (2/22) had partial responses after FSRT. Of the patients with normal pituitary function at baseline, 48% (14/29) experienced 1 or more hormone deficiencies after FSRT. Although 79% (60/76) of optic chiasms were at least partially within the planning target volumes, no patient experienced radiation-induced optic neuropathy. No patient experienced radionecrosis. No secondary malignancy occurred during follow-up.
  
  
  CONCLUSIONS
  In this study of long-term follow-up of patients treated for pituitary adenomas, FSRT was safe and effective.
authors: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada; Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada.
authors: Julian O
authors: JO
authors: Kim
authors: Roy
authors: R
authors: Ma
authors: Ryojo
authors: R
authors: Akagami
authors: Michael
authors: M
authors: McKenzie
authors: Michelle
authors: M
authors: Johnson
authors: Ermias
authors: E
authors: Gete
authors: Alan
authors: A
authors: Nichol
mesh_terms: D000236:Adenoma / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009897:Optic Chiasm / Q000528:radiation effects; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult