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Efficacy and safety of external beam radiation therapy in non-functioning pituitary adenomas: a case–control, nested in a cohort study

Published online by Cambridge University Press:  28 May 2013

Guadalupe Vargas ,
Baldomero González ,
Victoria Mendoza ,
Gerardo Guinto ,
Blas López-Félix  and
Moisés Mercado
Guadalupe Vargas
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Baldomero González
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Victoria Mendoza
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Gerardo Guinto
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Blas López-Félix
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
Moisés Mercado*
Affiliation:
Endocrinology Service/Experimental Endocrinology Unit, Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
*
Correspondence to: Moisés Mercado, Aristóteles 68, Polanco 11560, México City, México. Tel and fax: +5255-52813029 or +5255-52813029. E-mail: [email protected] or [email protected]
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Abstract

Background and objectives

Recurrence is frequent in surgically treated non-functioning pituitary adenomas (NFPA). The use of radiation therapy (RT) to prevent recurrence has to be weighted against the potential side effects, particularly, hypopituitarism. Our objective was to evaluate the efficacy and safety of RT in postoperative patients with NFPA with adenoma remnant.

Patients and methods

The 3- and 5-year outcome of 51 patients with NFPA with a remnant after surgery that received RT (cases) was compared with that of 61 subjects who did not receive RT (controls). Cases and controls were matched for postoperative remnant size, cavernous sinus invasion, age and gender.

Results

Tumour volume decreased in the radiated group from a median of 1,601 mm3 to 816 mm3 after 5 years of follow-up (p = 0·01, 50% tumour volume reduction). In the non-radiated controls median tumour volume decreased at 3 years but increased again after 5 years (baseline 1,415 mm3, 5 years 1,204 mm3, p = 0·93). Recurrence rate was 4% for the radiated group and 29% for the controls (OR 0·10, 95% CI 0·01–0·04, p = 0·02). Although pituitary hormone deficiencies at baseline were more prevalent in the radiated group, after 5 years, both groups showed a significant worsening of pituitary function. No RT-related side effects were recorded.

Conclusion

Postoperative RT is effective in preventing tumour regrowth in NFPA patients with postoperative remnants. The fact that hypopituitarism is highly prevalent even in non-radiated patients should allow a more generalised use of this treatment modality.

Keywords

hypopituitarismnon-functioning pituitary adenomaradiation therapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 1 , March 2014 , pp. 87 - 92
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

*

Guadalupe Vargas and Baldomero González have equally contributed to this work.

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