RESULTS OF PATIENTS WITH PITUITARY MACROADENOMAS TREATED WITH POSTOPERATIVE RADIOTHERAPY

Sixty patients with pituitary macroadenomas who had been treated in the years 1981-1996, by surgery and postoperative radiotherapy were retrospectively analyzed. Thirtyfive patients (58%) were male and 25 patients (42%) were female. The median age was 35,5. All the patients underwent surgery (73% transsphenoidal, 27% transcranial). Fourtysix (76%) patients had subtotal excision. Postoperative radiotherapy was started median 36 days after the surgery. Radiation therapy was delivered with Co60 or 9-18 MV linear accelerator. All patients were treated by two lateral parallel opposed fields to a total 50-54 Gy, with 1.8-2 Gy daily fractions in 5 weeks. Only one patient with gross residual received 60 Gy. The median follow-up was 62 months. The local control rates for 5 and 10 years were 75% and 60% respectively and the total survival was 93% for the same periods (Kaplan-Meier). Three patients were dead. One patient died as a result of the pituitary tumor, one of them died due to the complication of reoperation which was done for the recurrence of pituitary adenoma. The other patient died as a result of metastatic nasopharyngeal carcinoma. Symptomatic resolution observed in some of the patients whose symptoms were lasted after the surgery. High hormone levels decreased to normal limits in 52% of the patients with hypersecreting adenomas. Five patients developed hypopituitarism following therapy in median 42 months. In conclusion; although the local control rates were lower, the number of patients with subtotal excision were higher than the other studies which were reported. It could be sad that both surgery and radiotherapy were effective in symptom resolution.