An audit of over two decades of treating pituitary adenomas at a tertiary care facility

Aims: This retrospective audit of long-term outcomes and treatment sequelae with conventional radiotherapy (RT) is presented with an objective to provide baseline data with which outcomes of high precision techniques (fractionated radiosurgery and intensity-modulated RT [IMRT]) may be compared. Materials and Methods: Between the years 1990 and 2012, a total of 182 patients of pituitary adenoma were registered in the Department of Radiotherapy. Of these, 156 received RT. Immobilization consisted of a plaster of Paris cast (1990–1995), acrylic cast (1996–2000), a three-point head fixation thermoplastic cast (2001–2006), and now we are using “U”-IMRT thermoplastic cast since 2007 onward. A 2-field technique was used in 7% patients, whereas in the remaining 93% patients, 3-field technique was used. Forty-seven percent of patients were treated on a telecobalt unit and the remaining 53% patients on 6 MV linear accelerator. Rectangular fields, no field shaping, and appropriate wedges were used with mean field sizes (standard deviation [SD] and range) being 41.4 cm2 (16, 25–100). Mean dose (SD, range) was 47.5 Gy (SD 3.2; range 45–55) given in 1.8–2.0 Gy/fraction, 5 fractions/week. Results: Sixty percent of patients were (93/156) males. Median age was 37 years (mean - 37, SD - 13.2, range 12–66); 40.4% (63/156) had functional tumors. Presenting features were mainly headache 125 (80%), field defects 91 (58.3%), menstrual disturbances 33 (53% of women), and acromegalic features 38 (24.4%). Suprasellar extension, 129 (82.7%), was most common. All patients underwent resection; out of them, 28.2% patients had multiple surgeries. At a median (range) follow-up of 33 months (2–212) of all patients, the estimated freedom from progression was 96% at 2 years and 92% at 5 and 10 years with no patient failing beyond 18 months. Conclusions: Conventional external RT as described in postoperative cases of pituitary adenoma is safe and effective for tumor control with a median time to normalization of hormonal hypersecretion being about 30 months