There have been enormous advances in the medical and surgical management of pituitary tumours in recent years. Stereotactic radiotherapy has also allowed the use of more focused fractionated radiotherapy in the hope of minimising bystander damage and the long term sequelae of radiotherapy to the surrounding normal brain tissue.
With these advances, the number of patients requiring salvage treatment of any kind is reducing, and concerns persist about the long term safety of all forms of radiotherapy. However, there remains a small cohort of patients with refractory or recurrent disease despite all conventional treatments.
This presentation will include the latest data on the use of focused radiotherapy or radiosurgery to such difficult cases, following surgery and fractionated radiotherapy.
The largest group of patients treated with focused radiotherapy as a salvage treatment is acromegaly. This presentation will therefore concentrate on the efficacy of the treatment in this patient group, as well as reviewing both published and unpublished data from other tumours.
Such heavily pre-treated cases also have a high incidence of pituitary failure: 63% in one series. We will present data to suggest that further loss of pituitary function is common after the application of focused radiotherapy occurring in 66% of the remaining cases by 2 years, although in our series, no other adverse events have been recorded to date. The presentation will therefore discuss the safety data from both published and unpublished series in detail, and attempt to establish the best subset of patients in whom to consider this treatment modality.