Ninety patients were eligible and were sent questionnaires on quality of life, mood, and cognition. Eighty-one patients (49 men and 32 women, age 55 ±10 years) returned all questionnaires (response rate, 90%). Sixty-two had been operated by transsphenoidal route and 19 by craniotomy. Fourteen patients had needed a second surgical intervention. Subsequently, 46 of 81 subjects received additional RT after surgery because of a tumor remnant or regrowth. Average time between surgery and RT was approximately 8 months. Conventional external beam RT was administered in a daily dosage of 1.8 – 2.0 Gy, resul-ting in a total dose of 45 – 50 Gy, using a two-field opposed lateral technique or a three-, four- or five- field technique. All radiation treatment fields were applied daily, five times per week, with an overall duration of 35 days. In the time period 1963-1990, the radiation dose to the tumor was prescribed at the tumor encompassing isodose. From 1991 onward it was prescribed at a central point in the tumor, according to the recommendations of the International Commission on Radiation Units and Measurements.
Patient characteristics of those who received RT and those who did not are given in Table 1. Patients who underwent RT more frequently had a craniotomy, were younger at time of surgery, and their duration of follow-up was longer. They also used more hormonal substitution, although this only reached statistical significance for the use of thyroid hormone. Current age, social status, educational level, full-time/part-time employment, social security benefit, and comorbidity were all similar between both groups.

Most HR-QoL domains showed a similar score in patients who underwent RT, when compared with patients who did not receive RT (Table 2). However, physical functioning (effect Size [ES], 0.44), vitality (ES, 0.47), mood (HADS – depression) (ES, 0.56), and physical and mental fatigue (MFI-20) (both ES, 0.54) were reported to be significantly worse in patients who did not receive RT. No differences in cognitive function scores were observed. In the group that did not receive RT, social functioning, vitality, and gene-ral health perception (three domains of RAND 36), fatigue, and depression scores were significantly worse than in the reference population. In contrast, in patients who under-went RT only general health perception was less than in the reference population, whereas physical functioning, pain (RAND 36) and anxiety (HADS) were even better.
Table 2 Health related quality of life and cognition in patients with or without radiotherapy.

No differences in quality of life or cognitive functioning were observed related to the current age, age at primary treatment, primary surgical operation route, or the second surgical intervention. Hormonal substitution for loss of anterior pituitary function also had no effect on HR-QoL.
Multivariate analysis independently identified that RT, sex, cortisol substitution therapy, IGF-1 Z score < -2, and a second pituitary operation were independent determinants of quality of life (RAND 36) (Table 3). Improved RAND scores were seen in patients who received RT, in male patients, in patients with an intact corticotrophic axis, in patients with IGF Z score > -2, and in patients who underwent a second surgical procedure. Effect sizes of these independent variables ranged from 0.4 to 0.6.

Table 1 (click to view)	Table 2 (click to view)
Table 3 (click to view)