No single recommendation is appropriate for these neoplasms. Instead, surgical recommendation are specific to the patient, anatomy, previous surgery, and ability of the proton irradiation to maximally spare the critical structures of this area. Here, our team approach is manifested through regular meeting of the Skull Base Tumor Conference prior to recommendations and treatment. Pituitary Tumours Pituitary neoplasia treatment is in itself a varied discipline, incorporating the expertise of the MGH Departments of Neuroendocrinology , Neurosurgery , Radiation Oncology , and Massachusetts Eye and Ear Department of Ophthalmology. These tumours are often managed with initial resection, hormonal management, and close observation.
Irradiation is recommended upon tumor progression despite hormonal analogue blocking agents.
Retreatment of recurrent, previously irradiated pituitary tumors is provided by fractionated, proton irradiation designed to spare the visual system from further irradiation. As always close discussion of these complex cases is mandated and involves dialogue with referring neurosurgeons and endocrinologist. This complex group of tumours has been studied at the MGH over the past 5 years in a protocol designed to deliver a curative dose of irradiation to the entirety of these advanced tumors through the use of twice-daily irradiation, both with convention photon treatment and proton irradiation at the Harvard University Cyclotron. These tumours often invade the base of skull and surround the visual system, rendering the technical challenges in their irradiation to be amongst the most formidable in the field of radiation oncology. Our group has developed considerable experience and success in the treatment of these tumours using appropriate surgery preserving useful vision and precise stereotactic, fractionated proton irradiation to doses of 7600 cGy, drawing on our longer experience with the skull base tumors described above.