Kim 2013 (Pituitary Adenoma FSRT)

Background

Single-institution retrospective (Yonsei University, South Korea). N=92 pituitary adenomas (functioning and nonfunctioning) treated with fractionated stereotactic radiotherapy (FSRT) after transsphenoidal surgery/biopsy, 1999–2009. NFPA n=54, acromegaly n=24, prolactinoma n=9, Cushing's n=5. FSRT preferred for larger volume or optic-chiasm proximity.

Interventions and follow up

Treatment: Fractionated stereotactic RT (~50 Gy in 25 fractions) after transsphenoidal surgery for functioning and nonfunctioning pituitary adenomas
Primary endpoint: Tumor control (MRI), hormone normalization (functioning), visual/endocrine toxicity
mFollow up: Median 65 mo

Results

5-yr tumor control (all): 97.5%
Hormone normalization (functioning): 44% (17/38 at 5 yr)
New hypopituitarism: 23.9%
New visual deterioration: 3.3%

Adverse events

New hypopituitarism: 23.9% (lower than SRS series)
New visual field deficit: 3.3% (3 patients; all optic apparatus >54 Gy)
Grade 4–5 / radiation-induced neoplasia: None at median 65 mo
Neurocognitive outcomes: Not systematically assessed

Conclusions

FSRT achieves 97.5% 5-yr tumor control for pituitary adenomas of varied size/histology, with hormone normalization in 44% of functioning tumors and lower hypopituitarism than SRS series. FSRT particularly suited for larger tumors, optic-chiasm-adjacent disease, and visual compromise at presentation.

Key Limitations

Retrospective, single-institution; mixed histologies and small functioning subgroups limit hormone-normalization inference; no randomized comparison vs SRS; cognitive endpoints not captured.

Clinical Context

Supports FSRT as the preferred radiotherapy modality for large or chiasm-adjacent pituitary adenomas where single-fraction SRS would exceed optic-apparatus tolerance.

References