Local Control and Toxicity Assessment of Pituitary Adenoma Patients Treated with Different Radiotherapy Techniques
DOI:
https://doi.org/10.30683/1927-7229.2025.14.04Keywords:
Pituitary adenoma, stereotactic radiosurgery, hypopituitarism, radiotherapy outcomes, treatment-related toxicity, SRT, 3DCRTAbstract
Background: Pituitary adenomas often require radiotherapy (RT) for residual or recurrent disease, but optimal techniques balancing tumour control and toxicity remain debated. This prospective study compares outcomes between conventional and stereotactic RT approaches.
Methods: From 2014 to 2022, 22 patients with pituitary adenomas treated with RT were retrospectively enrolled (10 conventional RT [3DCRT/IMRT/VMAT], 12 stereotactic [SRS/fSRT]). All the patients disease, treatment and follow-up details were analyzed from the medical records. Primary endpoint was 3-year local control, secondary endpoints included toxicity (CTCAE v5.0) and endocrine function assessment.
Results: Stereotactic RT demonstrated superior 3-year local control (91.7% vs 80%, p=0.03) with lower hypopituitarism rates (33.3% vs 60%, p=0.02). All recurrences occurred in Knosp grade 3-4 tumours. Conventional RT was associated with higher pituitary doses (>45 Gy, OR 3.2, p=0.03 for hypopituitarism). No grade ≥3 toxicities occurred in either group. Visual complications were rare (8.3% stereotactic vs 20% conventional, p=0.39).
Conclusion: Stereotactic radiotherapy provides significantly better tumour control and endocrine preservation compared to conventional techniques for pituitary adenomas, particularly for non-invasive tumours. Dose constraints are critical for minimizing toxicity.
References
Minniti G, Clarke E, Scaringi C, Enrici RM. Stereotactic radiotherapy and radiosurgery for non-functioning pituitary adenomas: a meta-analysis. J Clin Endocrinol Metab 2016; 101(4): 1565-75.
Sheehan JP, Xu Z, Lobo MJ. External beam radiation therapy and stereotactic radiosurgery for pituitary adenomas. Neurosurg Clin N Am 2013; 24(4): 597-604.
Kotecha R, Sahgal A, Rubens M, De Salles A, Fariselli L, Pollock BE, et al. Stereotactic radiosurgery for non-functioning pituitary adenomas: meta-analysis and International Stereotactic Radiosurgery Society practice opinion. Neuro Oncol 2022; 24(3): 414-25.
Castinetti F, Nagai M, Dufour H, Kuhn JM, Morange I, Jaquet P, et al. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease. Eur J Endocrinol 2020; 182(3): 267-78.
Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma Knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery 2018; 82(3): 342-50.
Patt H, Jalali R, Yerram C, Gupta T, Goel A, Epari S. Hypopituitarism after conformal radiotherapy for pituitary adenomas: dosimetric analysis and prediction. Clin Endocrinol (Oxf) 2020; 93(3): 295-302.
Prabhu RS, Press RH, Patel KR, Boselli DM, Symanowski JT, Lankford SP, et al. Clinical outcomes of hypofractionated radiation therapy for pituitary adenomas. Pract Radiat Oncol 2019; 9(4): e401-e409.
Starke RM, Williams BJ, Vance ML, Sheehan JP. Radiation therapy and stereotactic radiosurgery for the treatment of Cushing's disease: an evidence-based review. Curr Opin Endocrinol Diabetes Obes 2021; 28(4): 356-64.
Peiffer AM, Leyrer CM, Greene-Schloesser DM, Shing E, Kearns WT, Hinson WH, et al. Neuroanatomical target theory as a predictive model for radiation-induced cognitive decline. Neurology 2022; 98(3): e239-e250.
van Beek AP, van den Bergh AC, van den Berg LM, van den Berg G, Keers JC, Langendijk JA, et al. Radiotherapy in acromegaly: long-term effects. Eur J Endocrinol 2020; 182(3): R1-R14.
Kong DS, Kim YH, Kim YH, Park K, Kim JH, Khang SK, et al. Long-term outcomes of fractionated stereotactic radiotherapy for large pituitary adenomas. J Neurooncol 2023; 161(2): 295-303.
Pomeraniec IJ, Kano H, Xu Z, Nguyen B, Siddiqui ZA, Silva D, et al. Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study. J Neurosurg 2021; 135(3): 648-58.
Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol 2022; 40(10): 1019-29.
Leavitt JA, Stafford SL, Link MJ, Pollock BE. Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2022; 103(3): 565-71.
Yamanaka R, Abe E, Sato A, Hayano A, Takashima Y. Secondary intracranial malignancies following radiotherapy for pituitary adenomas: a systematic review. Cancers (Basel) 2021; 13(4): 818.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Similar Articles
- K. Namratha, Geeta S. Narayanan, S. Arpitha, K.R. Sindhu, B.R. Kiran Kumar, Dosimetric Analysis of Organs at Risk and its Correlation with Radiation Techniques in Left-Sided Breast Radiotherapy , Journal of Analytical Oncology: Vol. 14 (2025)
- Rajesh Javarappa, Ramesh Bilimagga, V. Chendil, B.R. Kiran Kumar, Amrut S. Kadam, Acute Haematological Variations in Patients Receiving Radiotherapy and its Correlation with Volume of the Bone Marrow and Radiation Dose , Journal of Analytical Oncology: Vol. 9 (2020)
- A.S. Kirthi Koushik, R.C. Alva, Brachytherapy in Head and Neck Cancer: A Forgotten Art or a Skill to be Remembered!! , Journal of Analytical Oncology: Vol. 6 No. 1 (2017)
- Miklos L. Auber, Sijin Wen, Francesca Farran, Gerald M. Higa, Survival Outcomes in High-Risk, Resected Colorectal Cancer with and without Maintenance Therapy , Journal of Analytical Oncology: Vol. 12 (2023)
- Palak Lunkad, Deepika Malik, Sahil Shah, Mohini Gurjar, Virendra Bhandari, Incidental Diagnosis of Leptomeningeal Disease in Breast Cancer with Brain Metastases- a Case Report with Review of Literature , Journal of Analytical Oncology: Vol. 14 (2025)
- Sven Wenske , Philippa Cheetham, Aaron E. Katz, Clinical and Biochemical Outcomes of High-Risk Prostate Cancer Patients treated with Third Generation Prostate Cryosurgery , Journal of Analytical Oncology: Vol. 2 No. 2 (2013)
- Arun Chairmadurai, Harish Chandra Goel, Sandeep Jain, Aklank Jain, Hridayesh Prakash, Ra-SBRT is Potential Immune Adjuvant for Innate Immune Cell Populations in Advance Stage NSCLC Patients , Journal of Analytical Oncology: Vol. 8 (2019)
- Abigail Ruiz de Lobera, Aitziber Buqué, Alberto Muñoz, Sergio Carrera, Aintzane Sancho, Itziar Rubio, Eddy I. Gutierrez, Mikel Arruti, Inés Marrodán, Guillermo López-Vivanco, Bevacizumab in Combination with FOLFIRI in the First-Line Treatment of Patients with Advanced Colorectal Cancer: A Single-Institution Experience , Journal of Analytical Oncology: Vol. 3 No. 1 (2014)
- Pedro Salinas Hernández, Rafael Trujillo Vilchez, Antonio Arriví García-Ramos, Rosana Grande Ladron de Guevara, Angeles Rodríguez Jaraiz, Pedro Gallurt Moreira, Jose Maria Vieitez de Prado, Miguel Ruiz López de Tejada, Antonio Irigoyen Medina, Juan Manuel Campos Cervera, Juan Carlos Cámara Vicario, Uriel Bohn Sarmiento, Pedro López Tendero, Juan Domingo Alonso Lajara, Ana León Carbonero, Marisa García de Paredes, Juan de Alvaro Liaño, Asunción Juarez Marroquí, Luis López Gómez , Diego Soto de Prado Otero, Bevacizumab Plus Chemotherapy as First-Line Treatment for Patients with Metastatic Colorectal Cancer: Results from a Spanish Observational Study , Journal of Analytical Oncology: Vol. 2 No. 3 (2013)
- Eelco R.P. Collette, Monique J. Roobol, Prostate Cancer Treatment on the Basis of an Individual Risk Profile; Can we Reduce Overtreatment? , Journal of Analytical Oncology: Vol. 2 No. 1 (2013)
You may also start an advanced similarity search for this article.
Most read articles by the same author(s)
- Shreya Kottapalli, Maushmi Panamparampil Mahesan, Geeta S. Narayanan, B.R. Kiran Kumar, Assessment of Quality of Life in Head and Neck Cancer Patients before and after Radiation Therapy- A Prospective, Analytical Questionnaire-Based Study from a Tertiary Cancer Centre , Journal of Analytical Oncology: Vol. 13 (2024)
- Ravoori Harish Babu, Amritha Prabha Shankar, Geeta S. Narayanan, Ganesh M. Subramanya, B.R. Kiran Kumar, Association of Level III Axillary Lymph Node Positivity with Clinicopathological Characteristics in Breast Cancer , Journal of Analytical Oncology: Vol. 13 (2024)
- K. Namratha, Geeta S. Narayanan, S. Arpitha, K.R. Sindhu, B.R. Kiran Kumar, Dosimetric Analysis of Organs at Risk and its Correlation with Radiation Techniques in Left-Sided Breast Radiotherapy , Journal of Analytical Oncology: Vol. 14 (2025)
- B.R. Kiran Kumar, Geeta S. Narayanan, M.S. Ganesh, Amritha Prabha Shankar, Marjolins Ulcer: Clinicopathological Profile and Treatment Patterns , Journal of Analytical Oncology: Vol. 12 (2023)