TREATMENT OF NONFUNCTIONING CHROMOPHOBE ADENOMAS OF THE PITUITARY

One hundred and forty patients with chromophobe adenomas were treated by radiation therapy, surgical decompression, or surgical decompression followed by radiation therapy. The initial response of the visual fields was the same for each form of therapy. The long-term control rates at all intervals from 2 to 20 years were, however, much greater when irradiation was given. At 10 years the absolute control rate was 71 per cent for radiation therapy, 79 per cent for decompression plus irradiation, but only 9 per cent for surgery alone. It is probable that results for the irradiated groups would have been better if the doses had been higher in the earlier patients. After 10 years no patient without irradiation was free of recurrence.

No major complication could be attributed to irradiation. Surgical procedures, on the other hand, yielded a 7 per cent mortality rate, and 5 per cent of those operated experienced major damage to optic nerves or chiasm.

It is the author’s opinion that selected cases of presumed chromophobe adenoma, particularly if the patient is a poor surgical risk, may be treated by radiation therapy alone. When there is a reasonable doubt of the diagnosis, however, or a severe or recently changed visual field deficit, primary surgical decompression is necessary. If the primary therapy is irradiation, surgery should be reserved for irradiation failure. On the other hand, irradiation should be given postoperatively for all patients initially treated by surgery.

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