Radiotherapy of Pituitary Tumors

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Abstract
The use of the roentgen ray as a therapeutic procedure in the treatment of pituitary tumors was first instituted by Gramegna and Béclère over twenty years ago. The more recent reports in the literature by Sgalitzer (1), Béclère (2, 3), Heinismann (4) and others are indicative of the widespread and accepted use of this form of therapy. It is not our purpose to go into the historical difficulties in the treatment of pituitary tumors. It is sufficient to state that glandular and surgical methods have not always been rewarded by gratifying results. Hence, an addition to the therapeutic armamentarium which proves its value is an important contribution. The early successful efforts obtained with roentgen rays in treating hypophyseal tumors have been amplified by the favorable results noted in this country and abroad, e.g., Bailey (5), Borak, Grant (8), Sgalitzer (1). The experience thus gained enabled the observers to a certain extent also to predicate the type of tumor with which they were dealing by the type of response to the roentgen ray (radiosensitivity). Thus, cystic tumors of the pituitary are known to be highly radioresistant to deep X-ray therapy, while the eosinophilic adenomas respond with fair promptness (Sgalitzer, 1). This observation explains to some degree the great variability in the results obtained. Our present study is limited to thirteen cases in which the clinical picture of tumor in the pituitary region was manifested by visual disturbances, headache, dyspituitarism, and radiographic changes in the sella turcica. The salient features of the thirteen cases are best illustrated by the accompanying tabulation. Comment on Table A. Predominating Symptoms 1. Headache in five cases. 2. Visual disturbances in eleven cases (limitation of fields or diminution in visual acuity). 3. Polydipsia and polyuria in five cases. 4. Acromegaly or adiposo-genital dystrophy in eleven cases. 5. Menstrual disorders in seven of ten women. 6. Somnolence in three cases. B. Sex and Fertility Of the thirteen cases reported above, ten were females. As might be expected, menstrual irregularity or cessation of menses was a frequent symptom, occurring in seven patients. Of the nine married patients in this series, eight had children before the onset of symptoms while the ninth practised contraception. The male patients suffered from impairment of libido and potency. C. Sella Turcica Changes All cases except No. 3 and No. 11 showed definite erosion of the sella turcica. D. Type of Dyspituitarism Although evidence of a mixed type occurred in some cases, the classification was based upon the preponderant symptomatology.

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