Radiosurgery for pituitary adenoma

The role of irradiation in the management of pituitary adenomas is not well defined. Nevertheless, patients with residual or recurrent tumours have been treated with conventional external-beam radiotherapy and more recently with high-precision stereotactic techniques of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). We review some of the recently published articles on the efficacy and toxicity of SRS in the light of the current literature describing the results of conventional radiotherapy. While the general perception is that single-fraction SRS is more effective and less toxic than fractionated radiotherapy and in hormone-secreting tumours may produce a faster decline in elevated hormone levels, the available evidence suggests higher toxicity than seen with fractionated treatment without the reassurance of long-term tumour control. There is also no convincing evidence for more rapid reduction of elevated hormones. For the treatment of larger non-spherical pituitary adenomas, it may be appropriate to explore a potentially safer high-precision technique of fractionated conformal stereotactic radiotherapy (SCRT). In conclusion, there is currently little justification for the routine use of single-fraction SRS for the treatment of the majority of patients with benign pituitary adenomas.