Transsphenoidal Surgery

Transsphenoidal surgery is the most common procedure for pituitary tumors. In the most common form of this surgery, the doctor passes instruments through the nose to reach the pituitary gland through the sphenoid sinus in the back of the nose. The doctor then uses surgical instruments to remove the tumor.

Endoscopic transsphenoidal surgery

The term endoscopic transsphenoidal surgery is used when the doctor passes an endoscope, a fiber-optic scope with a camera and light on the end, through the nasal passages. The doctor then passes the endoscope through a small incision in the back of the nasal cavity and through the sphenoid bone to the pituitary gland, and uses the endoscope to remove the tumor.

Craniotomy

This surgery is performed less often than transphenoidal surgery, but may be used to treat larger or more advanced tumors. The doctor removes a part of the skull and removes the tumor through the hole. After a craniotomy, the doctor usually closes the hole by securing the piece of bone with metal clips.

Radiation therapy uses waves of high-energy rays produced by a machine to destroy tumor cells. Radiation therapy is used to treat pituitary tumors that cannot be surgically removed or are growing after previous treatment. Radiation therapy is also used to treat functioning tumors that have not responded to previous surgery and/or medications.

Collapsed Radiation Therapy Techniques

All of the techniques described below use an external source of radiotherapy (external beam radiotherapy). In all of these modalities, physicians will use MRI images (if available) combined with CT images obtained at time of simulation for radiation treatment planning. Immobilization devices will be used to keep the patient’s head in the same position for daily treatment of radiation. These devices include a mask for most treatments or a minimally invasive head frame for some types of stereotactic radiotherapy.

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Intensity-modulated radiotherapy: Intensity modulated radiotherapy (IMRT) uses even more X-ray beams and beam angles to permit variations in the dose pattern so that the tumor will receive a higher total dose than the normal tissues.

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Proton beam radiation therapy: Proton beam radiotherapy is a type of external beam radiotherapy that uses heavy charged particles (versus X-rays) that have a limited penetration in tissue. (X-rays pass all the way through the body.) Proton therapy focuses on radiating the tumor with a sharp decline on its exit route from the tumor, enabling minimal exposure to normal tissues. Its ability to spare normal tissues is superior to either 3D conformal or IMRT.

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Stereotactic radiation therapy: Stereotactic radiotherapy is a technique used to deliver very focused beams or arcs of radiation to produce a high dose to a small tumor target, with sharp dose fall off to protect the nearby normal tissues. Unlike the other treatments discussed above, stereotactic radiotherapy is delivered in one or just a few treatments

Medication

The doctor may recommend one or more medications that prevent pituitary tumors from overproducing certain hormones. These medications can reduce the symptoms of having high levels of these hormones, and can even shrink the tumor itself, and frequently eliminate the need for surgery in cases of prolactin producing tumors. The doctor may also recommend hormone replacement therapy for some pituitary tumors that cause abnormally low hormone levels.

Chemotherapy is rarely needed as malignant pituitary tumors are rare. Chemotherapy can be given as palliative treatment for pituitary carcinomas, to relieve symptoms and improve the patient's quality of life.

Clinical Trials

Clinical trials are studies of new cancer treatments that show promise but have not yet been proven effective in treating the disease. These trials may be the best treatment option for patients with pituitary tumors have not responded well to traditional treatments or that have limited treatment options.