Recurrent pituitary adenomas after surgical resection: the role of radiation therapy

Postoperative radiation therapy for pituitary adenomas is usually reserved for extensive lesions or those that are incompletely resected. Nineteen patients who received external beam radiation as a salvage procedure after recurrence following surgery alone for pituitary adenomas were studied. At recurrence, nine patients underwent reexcision. All 19 patients underwent external beam irradiation for salvage. Within a median follow-up time of 11.8 years from the time of surgical failure, two patients have died of progressive adenoma, two are alive with disease progression, eight are alive without disease progression, and seven have died of intercurrent disease. The 5-, 10-, 15-, and 20-year overall actuarial (and progression-free) survival rates were 79% (90%), 62% (90%), 44% (80%), and 44% (53%), respectively. Dose of radiation, suprasellar extension at the time of surgical failure, and histologic findings had no bearing on prognosis. One patient developed a radiation-induced brain necrosis that was successfully resected. Radiation therapy can be an effective salvage modality for recurrent pituitary adenomas after surgical failure.