title: Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response.
abstract: OBJECTIVE
  We describe the use of fractionated stereotactic radiotherapy (FSRT) for the treatment of large, invasive, nonfunctioning pituitary adenomas (NFPAs). FSRT is frequently employed for the treatment of residual or recurrent pituitary adenomas.
  
  
  METHODS
  Sixty-eight patients with a large residual or recurrent NFPAs were treated between April 2004 and December 2012, including 39 males and 29 females (median age 51 years). Visual defects were present in 34 patients, consisting of visual field defects (n=31) and/or reduced visual acuity (n=12). Forty-five patients had evidence of partial or total hypopituitarism before FSRT. For most of the patients, the treatment was delivered through 5-10 noncoplanar conformal fixed fields using a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions.
  
  
  RESULTS
  At a median follow-up of 75 months (range 12-120 months), the 5- and 10-year actuarial local control were 97 and 91%, respectively, and overall survival 97 and 93%, respectively. Forty-nine patients had a tumor reduction, 16 remained stable, and three progressed. The relative tumor volume reduction measured using three-dimensional (3D) magnetic resonance imaging (MRI) was 47%. The treatment was well tolerated with minimal acute toxicity. Eighteen patients developed partial or complete hypopituitarism. The actuarial incidence of new anterior pituitary deficits was 40% at 5 years and 72% at 10 years. No other radiation-induced complications occurred.
  
  
  CONCLUSIONS
  Our results suggest that FSRT is an effective treatment for large or giant pituitary adenomas with low toxicity.
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy gminniti@ospedalesantandrea.it.
authors: Giuseppe
authors: G
authors: Minniti
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Claudia
authors: C
authors: Scaringi
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Maurizio
authors: M
authors: Poggi
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Marie Lise
authors: ML
authors: Jaffrain Rea
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Giuseppe
authors: G
authors: Trillò
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Vincenzo
authors: V
authors: Esposito
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Alessandro
authors: A
authors: Bozzao
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Maurizio Maurizi
authors: MM
authors: Enrici
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Vincenzo
authors: V
authors: Toscano
authors: Radiation Oncology UnitSant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, ItalyIRCCS NeuromedPozzilli, Isernia, ItalyEndocrinology UnitNeurosurgery UnitNeuroradiology UnitOphthalmology UnitSant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Riccardo Maurizi
authors: RM
authors: Enrici
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult