Brand Alexandra, Agolli Linda, Tas Kerem Tuna, Lishwiski Phillip, Schymalla Markus, Zink Klemens, Vorwerk Hilke, Fragkandrea-Nixon Ioanna, Held Thomas, Habermehl Daniel, Adeberg Sebastian, Gawish Ahmed
Department of Radiotherapy and Radiation Oncology, Philipps- Universität Marburg, Marburg, Germany.
Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, Marburg, Germany.
J Neurooncol. 2025 Sep 10. doi: 10.1007/s11060-025-05228-1.
Pituitary adenomas are relatively common benign intracranial tumors that may cause significant hormonal imbalances and visual impairments. Radiotherapy (RT) remains an important treatment option, particularly for patients with residual tumor after surgery, recurrent disease, or ongoing hormonal hypersecretion. This study summarizes long-term clinical outcomes and radiation-associated toxicities in patients with pituitary adenomas treated with contemporary radiotherapy techniques at a single institution.
A retrospective analysis was conducted on 122 patients treated with RT for pituitary adenomas at the tertiary Hospital in Germany between 1992 and 2023. Patient data were assessed for tumor characteristics, treatment modalities, and outcomes. Overall survival (OS), and local control (LC) were evaluated using Kaplan-Meier analysis. Statistical comparisons between subgroups were performed with the log-rank test. Treatment-related toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0.
Median follow-up was 107 months from initial diagnosis and 63 months post-RT. Most patients (96%) received fractionated stereotactic radiotherapy (FSRT), and 4% underwent single-session radiosurgery. RT achieved LC rates of 95% and 75% at 5 and 20 years, respectively. Proton therapy significantly improved LC and overall survival (OS) compared to photon-based treatments (p < 0.01). Hypopituitarism was the most common long-term toxicity, occurring in 40% of patients, while visual impairments were rare (< 3%). Tumor recurrence occurred in 9% of patients, primarily in those treated with delayed RT after incomplete resection.
Modern RT techniques, particularly proton therapy, provide durable tumor control and manageable toxicity profiles for pituitary adenomas. Optimized timing and precision in RT delivery are critical to enhancing outcomes and minimizing complications. Long-term follow-up remains essential to monitor disease progression and late toxicities.
垂体腺瘤是相对常见的颅内良性肿瘤，可导致显著的激素失衡和视力损害。放射治疗（RT）仍然是一种重要的治疗选择，特别是对于术后残留肿瘤、复发性疾病或持续性激素分泌过多的患者。本研究总结了在单一机构采用当代放射治疗技术治疗的垂体腺瘤患者的长期临床结果和放射相关毒性。
对1992年至2023年期间在德国三级医院接受RT治疗垂体腺瘤的122例患者进行回顾性分析。评估患者数据的肿瘤特征、治疗方式和结果。采用Kaplan-Meier分析评估总生存期（OS）和局部控制率（LC）。亚组之间的统计比较采用对数秩检验。根据不良事件通用术语标准（CTCAE）第5.0版对治疗相关毒性进行分级。
从初始诊断起的中位随访时间为107个月，放疗后为63个月。大多数患者（96%）接受了分次立体定向放射治疗（FSRT），4%接受了单次放射外科治疗。放疗在5年和20年时的局部控制率分别为95%和75%。与基于光子的治疗相比，质子治疗显著提高了局部控制率和总生存期（p<0.01）。垂体功能减退是最常见的长期毒性，发生在40%的患者中，而视力损害很少见（<3%）。9%的患者出现肿瘤复发，主要发生在不完全切除后接受延迟放疗的患者中。
现代放疗技术，特别是质子治疗，为垂体腺瘤提供了持久的肿瘤控制和可管理的毒性特征。放疗实施的优化时机和精度对于提高疗效和减少并发症至关重要。长期随访对于监测疾病进展和晚期毒性仍然至关重要。
