Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas

Prognostic factors and results of therapy were analyzed in a retrospective review of 70 patients with pituitary adenomas treated with radiotherapy alone from January 1954 through December 1982 at the Radiation Oncology Center, Mallinckrodt Institute of Radiology. The 10-year overall and disease-free survival was 77.8 and 76.0%. The expected survival for an age-, sex-, and race-matched population was not significantly greater at 87.2%. The 10-year disease-free survival for the distinct tumor types was 100% for Cushing's disease, 82.3% for patients with amenorrhea/galactorrhea, 79.6% for non-functioning adenomas, 69.0% for acromegaly, and 66.7% for Nelson's syndrome. Prognostic variables analyzed were age, race, sex, tumor type, tumor extent, visual field defects at diagnosis, and volume irradiated. Only the presence of visual field defects at diagnosis conferred a poor prognosis (p < 0.001). There was a tendency toward superior tumor control with radiation doses greater than 4500 cGy (p = 0.15). The median time to progression of disease was 4.2 years, with the last failure occurring at 12 years following the completion of radiotherapy. Severe complications were apparent in 5 patients (7.1%), including one death from central nervous system radionecrosis.