Nonfunctioning pituitary adenomas (NFAs) are the most common tumors of the anterior pituitary. Transsphenoidal surgery is the treatment of choice, but complete surgical removal is frequently not achieved. Radiotherapy (RT) is often given as adjuvant treatment in the postoperative period to patients with a tumor remnant or regrowth. Retrospective studies show that RT can effectively reduce the chance of tumor regrowth, as reviewed by several investigators1-3. Current medical practice involves RT for large postoperative tumor remnants and sequential MRI surveillance for smaller tumors followed by RT in the presence of tumor expansion in many centers1,4. The restrictive use of postoperative RT for NFAs is a consequence of absence of regrowth in a number of cases, the excellent local control with radiation therapy when applied at time of recurrence, and concerns related to possible long-term side effects5. The most important of these complications is radiation-induced hypopituitarism and its associated excess morta-lity6, although the role of RT per se on pituitary function remains disputed7. Radiation-induced tumor formation and damage to the optic chiasm are also reported but are considered rare under modern RT dosing schedules8-10. In addition, neuropsychological changes after pituitary RT have been reported11-17. However, many studies on this subject are undersized, and results are potentially confounded by inhomogeneous group composition and incomplete hormonal substitution. Further, type and date of surgery, age, and duration of follow-up have usually not been taken properly into account to assess the impact of modern RT.
With these considerations in mind, we sought to determine whether the use of RT in the postoperative period has a significant effect on health-related quality of life (HR-QoL) and cognitive function. We report data from a large and homogeneous cohort of patients with NFAs.