Pituitary Tumors

Treatment

After the tumor is found, the physician discusses treatment options with the patient and family. It is important to consider all of the choices.

Three treatments are used, alone or in combination. Surgery may be used to remove the tumor. Radiation therapy may be used to kill tumor cells. Chemotherapy (to block excess hormone secretion, and sometimes, shrink the tumor)

Surgery

The main treatment is surgery. The effectiveness of surgery depends on the tumor's type, location, size, and whether it has spread into nearby tissues. There are three main surgical techniques.

Transphenoidal Hypophysectomy

The tumor is reached and removed through the nasal cavity. Advantages of this surgery are that no other part of the brain is touched, the neurological complication rate is low, and there is no visible scar. However, removing large tumors is difficult. If the tumor is a microadenoma, then the cure rates are high (greater than 80 percent) if done by an experienced neurosurgeon. If the tumor is large or has invaded the nearby nerves or brain tissue, chances diminish for a surgical cure.

Traditionally, this approach involved an incision under the lip and postoperative nasal packing. Currently, with advances in neurosurgical techniques, the operation can usually be done through the nose without an external incision. The hospital stay is usually one night.

Transcranial Hypophysectomy

This technique approaches the tumor through the upper part of the skull and usually is the procedure of choice for large and complicated tumors. Patients can often leave the hospital four days after surgery.

Read article on endoscopic transnasal surgery from Clinical Update (PDF).

Computer-Assisted Surgery for Tumor Removal

In traditional craniotomies (skull surgery), incisions have to be large enough to ensure that the surgeon can find the brain tumor within the opening. At Mayo Clinic, stereotactic (from Greek: stereo – three dimensions; tactic – to probe) methods in brain tumor surgery have significantly reduced the invasiveness of surgical procedures to remove brain tumors.

Radiation Therapy

Radiation uses high-energy rays to destroy tumors, alone or following surgery. It may also be used if surgery is not possible. Radiation therapy is often recommended when pituitary tumors persist or return after surgery and cause symptoms not relieved by medications.

External-beam Radiation

This traditional therapy delivers radiation from outside the body. The radiation comes from a large machine, and treatments usually are given five times a week over four to six weeks on an outpatient basis.

Although effective, this therapy has some disadvantages. It can take years before the tumor growth and/or hormone production are fully controlled. Also, this therapy cannot avoid damaging the remaining normal pituitary cells. In most cases, normal pituitary function will eventually be lost. Also some normal brain tissue may be damaged, particularly those areas near the pituitary gland.

Stereotactic Radiosurgery

Some intriguing new methods in brain tumor treatment involve this type of radiation. The treatment precisely focuses radiation beams to the tumor. No scalpels are involved. Gamma Knife™ (stereotactic radiosurgery) delivers radiation beams to match the tumor precisely with the aid of brain imaging techniques.

The advantage of stereotactic radiosurgery is that surrounding, healthy tissue receives minimal radiation compared to the tumor. It may be used with external-beam radiation, especially for tumors in deep or sensitive areas of the brain, where surgical removal is dangerous. It is a one-day outpatient procedure.

Like conventional radiation therapy, the benefit of stereotactic radiation is also not immediate and may take months or years to be fully effective. Although this technique is relatively new, early results are very encouraging. Unfortunately, this therapy cannot be used for tumors very close to important nerves, such as those needed for vision. It still is most often recommended when surgery has not been successful.

This technique has other advantages over traditional surgeries:

• The patient can avoid the pain and discomfort of a craniotomy
• The procedure is performed under local anesthesia and does not require any time in an intensive care unit
• As an outpatient procedure, there is little or no convalescent time; patients can resume their normal activities the following day
• Radiosurgery can be used for patients with tumors located in brain areas that are considered high-risk for scalpel or laser surgery

Chemotherapy

Chemotherapy can decrease the excess hormone production from pituitary tumors, or block the effects of these hormones. Prolactin-producing tumors may also shrink with medical therapy. Hormones that become deficient are replaced through medication.

New and Experimental Treatments

In addition to current treatments, new technology is evolving to help treat pituitary tumors more precisely. Promising new medications are becoming available to treat overproduction of hormones by some tumors.