Evaluation of Results of Treatment in Pituitary Tumors

Abstract

Evaluation of results of treatment in tumors of the pituitary, particularly the chromophobe adenomas, is difficult if not impossible. The great advances in replacement therapy with hormones have decreased the surgical risk, prolonged the survival, and aided the rehabilitation of these patients. Survival, a frequently used measure in malignant disease, is not helpful in establishing success or failure of treatment in these tumors (death caused by or during treatment excepted). Pituitary failure is usually not reversed, but is controlled by replacement therapy. It seems logical to assume, however, that a defect in the visual field which disappears or grows smaller following treatment of the pituitary tumor represents a shrinkage of the tumor. A guide for the quantitative measurement of visual impairment employing visual field defect and change in visual acuity is available (2), so that the changes in visual fields produced by the pituitary can be ascertained. While this method was developed to determine visual impairment for compensation purposes, it would seem applicable to the measurement of visual impairment caused by pituitary tumors. Elsewhere in this issue Colby et al. (1) report on their findings when they employed this technic in the evaluation of 74 patients with chromophobe adenomas with visual impairment. The amount of impairment was measured prior to radiation therapy, as were the quantitative changes in this defect following treatment. In many institutions the presence of a visual field defect is the indication for surgical intervention in patients with pituitary tumors. These results and those of a similar group of patients treated by surgery, soon to be published, should be of interest to neurosurgeons, radiologists, and other physicians interested in the management of patients with chromophobe adenomas of the pituitary. Furthermore, those interested in a possible method for evaluation of results of treatment in pituitary tumors are urged to read the article cited as Reference 2 below.