Yonsei Med J.  2022 Dec;63(12):1059-1068. 10.3349/ymj.2022.0323.

Radiation Therapy for Recurrent or Residual Pituitary Macroadenoma Invading Extrasellar Structures

• Kim K
• Cho J
• Moon JH
• Kim EH
• Yoon HI

• KMID: 2536355
• DOI: http://doi.org/10.3349/ymj.2022.0323

Abstract

Purpose
This study aimed to evaluate the efficacy of radiation therapy (RT) for recurrent or residual pituitary macroadenoma (PMA) invading extrasellar regions.
Materials and Methods
Patients from 2000 to 2020 who received RT with conventional fractionation for recurrent or residual PMA were included. The patients were divided according to the type of tumor [functioning (fx) or non-fx] and the aim of RT (salvage RT alone, immediate postoperative RT, delayed postoperative RT). Local and biochemical failure-free rates (FFR) were calculated using the Kaplan–Meier method.
Results
With a median follow up of 82 months (IQR; 42–132 months), 36 patients treated with conventional RT (total 45–54 Gy in 1.8 or 2 Gy per fraction) for recurrent or residual PMA were analyzed. The 10-year local FFRs after RT for non-fx and fx tumor were 100% and 74.4%, respectively (p=0.047). In the immediate postoperative RT group, the 10-year local FFR was 100%, which was higher than the 90% FFR for salvage RT alone or 80% FFR for the delayed postoperative RT group (overall p=0.043, immediate vs. salvage; p=0.312, immediate vs. delayed; p=0.072). The local FFR was compared according to size of tumor with a cut-off value of 4 cm, and there was no significant difference (10-year local FFR 100% vs. 84.7% for >4 cm vs. <4 cm, p=0.320). The extents of extrasellar region invasion were not predictive of local failure after RT. We found no grade ≥3 acute toxicities or newly developed visual impairments as a late toxicity of RT.
Conclusion
Conventional RT is safe and effective for the local control of recurrent or residual PMA. Our data suggest that immediate postoperative RT can be beneficial in recurrent or residual PMA, although further studies to evaluate risk factors of treatment failure in terms of treatment and disease characteristics are required.

Keyword

Pituitary macroadenoma; radiation therapy; extrasellar invasion; local failure; biochemical failure