External beam radiation therapy for pituitary adenomas has been applied for more than 100 years and the first results were reported by Beclere and Gramegna, two French physicians in 190940.
Because of a high operative mortality in the early 20th century, radiation therapy was a primary method of treatment at that time. Surgery, however, was the only method to restore vision. Gradually, it was discovered that surgery followed by radiation therapy was more effective than surgery alone41. In the sixties, there were differences in opi-nion regarding the role of radiation therapy in NFA. Some investigators in the USA advocated primary radiation therapy, but others recommended surgery followed by radiation therapy, promoted also by the British and Scandinavian schools. Nowadays, because of improved neurosurgical techniques, surgery is the treatment of choice in NFA with compression. Primary radiation therapy is only applied if the patient refuses surgery or the general condition of the patient does not allow neurosurgery.
Immobilisation of the head of the patient to apply more precisely the radiation therapy to the tumour has been improved, starting with no immobilisation devices, followed by tape and later on by immobilisation masks and stereotactic frames.
Outlining the tumour for target volume definition in radiation therapy has been improved due to better imaging techniques. In the beginning, plain skull films, pneumo-encephalography and later on cerebral angiography were used in outlining the tumour with its suprasellar and parasellar extension. Since the availability of CT-scans in the seventies this technique has been used for tumour outlining, followed by MRI 10 years later. Nowadays, MRI is the preferred modality – if applicable and available – for primary evaluation of the pituitary gland and outlining the tumour for radiation therapy co-registered with the planning-CT scan42.