Radiotherapy for non-functioning pituitary tumors--when and under what circumstances?

The role of pituitary radiotherapy (RT) in the management of clinically non-functioning pituitary tumors (NFTs) remains controversial. Observational studies suggest that RT is effective in preventing the regrowth of NFT remnants following initial surgical debulking. However, not all tumor remnants will regrow in the absence of pituitary RT. Furthermore there are concerns relating to potential complications of pituitary RT, particularly hypopituitarism and its associated excess mortality. In the absence of any clear consensus guidelines relating to the application of pituitary RT in this setting, the following text sets out to review the evidence base for the efficacy of RT in preventing NFT regrowth and attempts to balance this against the potentially deleterious consequences of pituitary RT. A pragmatic approach is adopted with a view to offering clinically relevant guidance for managing patients with postoperative NFT remnants.