Pituitary adenoma: results of combined surgical and radiotherapeutic treatment of 260 patients.

Abstract

Several variants of surgical and radiotherapeutic technique have been employed in the treatment of pituitary adenoma, and this is reflected by the number of reports that have appeared. The earliest surgical approach was by the intracranial route (Horsley, 1906a, 1906b), which remains in use today, though the endonasal route was popular for a time (Cushing, 1912) and is still employed by some surgeons for ablation of the normal pituitary gland. Treatment of a series of patients by radiotherapy was first reported by Heinismann and Czerny (1926) ; sub sequently, primary treatment by radiotherapy became customary only for tumours that did not interfere with vision, while post operative irradiation was employed to reduce the incidence of recurrent tumour (Henderson, 1939). Despite the difference between patients treated surgically and those receiving radio therapy, particularly in the size of tumour and in the criteria adopted for diagnosis, most studies have reported both groups of patients together. For example, Henderson's (1939) report of 338 patients treated by Cushing includes patients operated on through both endonasal and intracranial routes, not all of whom received irradiation ; while another large study, that of Bakay (1950), comprises 292 patients similarly operated on by different methods and also given radiotherapy either before or after operation. Variations in treatment also occur in the studies of Horrax et al. (1952, 1955), N?rnberger and Korey (1953), Mogensen (1957), Ray and Patterson (1962), and Poppen (1963). By contrast, the 260 patients in the present series were treated by the same surgical technique, and, with few exceptions, by subsequent radiotherapy.