AUTHOR=Nicholas Sarah E. , Salvatori Roberto , Quinones-Hinojosa Alfredo , Redmond Kristin , Gallia Gary , Lim Michael , Rigamonti Daniele , Brem Henry , Kleinberg Lawrence 

TITLE=Deferred Radiotherapy After Debulking of Non-functioning Pituitary Macroadenomas: Clinical Outcomes

JOURNAL=Frontiers in Oncology

VOLUME=8

YEAR=2019

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2018.00660

DOI=10.3389/fonc.2018.00660

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold> To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression.</p><p><bold>Methods:</bold> Two hundred and sixty-seven patients were treated surgically for pituitary tumors at our institution between 1997 and 2005. One hundred and twenty-six patients met the inclusion criteria of NFPMA. They were followed for at least 2 years.</p><p><bold>Results:</bold> At presentation, 58% of patients had objectively decreased visual function, 66% had endocrine abnormalities, and 46% had headaches. Of the entire cohort, 75% of tumors abutted the optic chiasm and 87% had suprasellar extension. Over a median follow up of 112 months from surgery, 52% of patients had evidence of radiographic tumor progression, and 39% required additional treatment. There was a significant difference freedom from progression and in the number of patients receiving additional treatment with preoperative adenoma size of &lt; 2 vs. ≥2 cm (<italic>p</italic> &lt; 0.05).</p><p><bold>Conclusion:</bold> Close observation with radiation therapy delayed until the time of progression is an appropriate option for patients presenting with initial adenoma size &lt; 2 cm, and can be considered for those with initial sizes up to 4 cm, as the majority of patients do not require further intervention for 10 or more years, thereby meaningfully postponing the risks of radiotherapy.</p>