AN AUDIT OF SELECTED PATIENTS WITH NONFUNCTIONING PITUITARY-ADENOMA TREATED BY TRANSSPHENOIDAL SURGERY WITHOUT IRRADIATION

OBJECTIVE To determine whether the rate of tumour regrowth in patients with non-functioning pituitary tumour treated by transsphenoidal surgery and selected for observation without post-operative irradiation is acceptably low, and to identify a group of patients who could appropriately avoid pituitary irradiation. SUBJECTS One hundred and thirty-two patients treated by transsphenoidal surgery, of whom 98 did not undergo post-operative irradiation. These 98 were selected as having had apparently complete surgical removal, and as lacking features of tumour invasion or rapid growth; 73 of them are being followed by serial pituitary imaging to detect tumour regrowth. RESULTS Forty-two patients who have been imaged on two or more occasions or more than two years after operation have shown no sign of tumour regrowth; 25 of them have been imaged at 3 or more years after operation, 13 at more than 5 years, and 4 at more than 10 years. Eight patients have shown regrowth as judged by imaging, although only one had pressure symptoms at the time; 5 out of 6 of these recurrences were found within 5 years of operation (two cannot be timed). The unirradiated group of 73 patients showed 90% recurrence-free survival at 5 years (95% confidence limits 80-100%). CONCLUSIONS Provided that careful surgery and meticulous recall mechanisms for imaging can be ensured, patients so selected may be given the information contained in these results and offered the choice of follow-up by imaging atone, without pre-emptive irradiation. We recommend that they should be imaged 6-8 weeks post-operatively, then at either 6 or 12 months depending on the appearance, and then every 3-5 years for at least 15 years. By this means, many patient-years of good health and relative medical independence can be gained, together with some financial saving.