[Value of postoperative radiotherapy in various tumors of the pituitary gland]. / Intérêt de la radiothérapie postopératoire dans certaines tumeurs de l'hypophyse.

Already advocated by Cushing to complement surgery of pituitary adenomas, radiotherapy remains useful in these benign tumours despite controversies concerning long-term results, pituitary cell resistance and potential harmful effects on the optic nerve, glands and skin. Radiotherapy was applied to 36.6 p. 100 of 150 patients with pituitary tumours operated upon by the same surgical team. Some very good results were obtained, notably in invasive and recurrent tumours. In a case of chromophobe adenoma operated twice at 1 year interval, radiotherapy (4,500 rads) after the second operation resulted in complete cure confirmed by computerized tomography 15 years later. Similarly, in an 8-year old girl reoperated upon for severe recurrent suprasellar craniopharyngioma 3 years after the initial excision, post-operative radiotherapy (5,000 rads) produced excellent remission which persists after 19 years. Thus, even with the modern diagnostic and microneurosurgical procedures, radiotherapy remains, for many authors, a useful and safe method to improve the prognosis of pituitary tumours.

Treatment and recurrences in 135 pituitary adenomas.

In 135 operated pituitary adenomas of different histological nature, seen over 20 years, the initial treatment was surgical, by trans-sphenoidal or transcranial approach depending on the tumour extent, followed by radiotherapy if necessary. In spite of modern investigation methods, diagnosis is still often made late, so that 118 of our cases already had visual symptoms. After surgery alone (87 cases) made by the same team recurrences occurred in 16%. Reoperations (14 cases) were generally more difficult and could also be followed by new recurrences needing finally radiotherapy with still positive results. Two cases had initial radiotherapy, the other 46 cases were treated by surgery and radiotherapy with a recurrence level of 8.3%. These results indicate the need to use immediate postoperative radiotherapy in every pituitary adenoma showing even the slightest invasive potential because radical surgery is hypothetical and recurrences possible. The recurrence of pituitary adenomas remains a difficult problem of anticipation and of curative management. Our position in terms of these benign tumours is to adopt readily this therapeutic course: surgery followed by radiotherapy, which provides the best prognosis without major risks.