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IS RADIOTHERAPY EFFECTIVE IN THE MANAGEMENT OF PITUITARY TUMOURS? THE NHS TAYSIDE EXPERIENCE Free

INTRODUCTION: Radiotherapy is a potential treatment of pituitary adenoma, after incomplete excision or when hormone secretion remains problematic. We audited outcomes of patients in NHS Tayside who have received radiotherapy for pituitary tumours. METHOD: Patients between 2000 and 2014 were identified using the departmental database. Patient notes and computer records reviewed. Type of pituitary adenoma, dose of radiotherapy, dates of treatment, tumour re-growth, control of hormone production, and complications were recorded. RESULTS: 38 patients identified, 3 excluded due to lack of data. 35 assessed, with 10 non-functioning and 25 functioning tumours. Of the functioning tumours, 7 growth hormone (GH); 7 adrenocorticotrophic hormone (ACTH); 7 follicular stimulating hormone (FSH); 4 prolactin (PL) and 1 leutenising hormone (LH). Of these, one was mixed producing both PL and GH. All patients with functioning-pituitary tumours had hormone secretion brought under improved control. Median follow-up 80 months. 9/10 (90%) patients with non-functioning adenomas had no evidence of tumour recurrence on serial MRI. One patient had tumour recurrence and died at second surgery. Median follow-up 78.5 months. No long term complications identified. CONCLUSION: Radiation therapy is an effective adjunct in managing both functioning and non-functioning pituitary tumours, with 100% and 90% control rates respectively. Long term neuro-imaging and endocrinological assessments are essential, as delayed complications can arise after treatment, but our practice of 45Gy in 25 fractions appears to be safe with no long-term negative sequelae.