Radiotherapy and stereotactic radiosurgery for pituitary tumors.

Based on a review of the literature and our medical center experience, we believe that transphenoidal surgery is the procedure of choice in most patients with pituitary adenomas. Conversely, SRS is a procedure of choice for those with cavernous sinus involvement. Patients with incomplete surgical excision should be considered either for a planned stereotactic treatment or for external beam radiotherapy. The same applies to patients with recurrent tumors. We favor stereotactic treatment in patients who have tumors that are less than 35 mm in diameter and at least 3 mm from the chiasm or optic nerves. Other patients should be considered for three-dimensional conformal radiotherapy. Radiotherapy provides a good treatment alternative in those patients who either refuse surgery or have contraindications to this therapy. Contemporary radiotherapy and SRS for pituitary adenomas is safe and effective treatment. This treatment should be undertaken in medical centers with appropriate expertise and instrumentation.