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Observation Alone after Transsphenoidal Surgery for Nonfunctioning Pituitary Macroadenoma

Departments of Endocrinology and Metabolic Diseases (O.M.D., A.M.P., F.R., M.A.S., J.W.A.S., J.A.R.), Neurosurgery (J.H.C.V.), and Radiotherapy (K.J.N.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands

Address all correspondence and requests for reprints to: O. M. Dekkers, M.D., M.A., Department of Endocrinology and Metabolic Diseases C4-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail: o.m.dekkers{at}lumc.nl.

Objective: Transsphenoidal surgery is the treatment of choice for nonfunctioning pituitary macroadenomas (NFMA). In this study we evaluated the long-term effects of a treatment strategy in which postoperative radiotherapy was not routinely applied to patients with NFMA.

Design: This was a retrospective follow-up study.

Patients: We included 109 consecutive patients (age 56 ± 13 yr) operated for NFMA between 1992 and 2004.

Results: Radiological imaging revealed a macroadenoma in all patients, with suprasellar extension in 96% and parasellar/infrasellar extension in 36% of cases. Visual field defects were present in 87% of the patients and improved in 84% of these patients after surgery. Only six patients received postoperative radiotherapy. Ten patients died during the follow-up period. Ninety-seven patients could be assessed for tumor regrowth or tumor recurrence after a mean follow-up period of 6.0 ± 3.7 yr. In nine patients there was evidence for tumor regrowth, and in one patient tumor recurrence was observed. The mean time to tumor growth/recurrence after initial therapy was 6.9 (range 3–12) yr. Follow-up duration was found to be an independent predictor for tumor regrowth.

Conclusion: Transsphenoidal surgery without postoperative radiotherapy is an effective and safe treatment strategy for NFMA, without evidence for tumor regrowth in 90% of all patients, at least for the duration of follow-up presented in this study. Additional studies are required to exclude higher regrowth and recurrence rates during prolongation of the duration of follow-up.

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