{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:52:02Z","timestamp":1760241122232,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T00:00:00Z","timestamp":1574812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>High-precision radiotherapy has been established as a valid and effective treatment option in patients with pituitary adenomas. We report on outcome after fractionated stereotactic radiotherapy (FSRT) in correlation with patient-reported outcomes (PROs). We analyzed 69 patients treated between 2000 and 2019. FSRT was delivered with a median total dose of 54 Gy (single fraction: 1.8 Gy). PRO questionnaires were sent to 28 patients. Median overall survival was 17.2 years; mean local control was 15.6 years (median not reached). Median follow-up was 5.8 years. Twenty (71%) patients participated in the PRO assessment. Physicians reported symptoms grade \u22653 in 6 cases (9%). Of all, 35 (51%) patients suffered from hypopituitarism at baseline, and during follow-up, new or progressive hypopituitarism was observed in 11 cases (16%). Patients reported 10 cases of severe side effects. Most of these symptoms were already graded as CTCAE (Common Terminology Criteria for Adverse Events) grade 2 by a physician in a previous follow-up exam. PROs are an essential measure and only correlate to a certain extent with the physician-reported outcomes. For high-precision radiotherapy of pituitary adenomas, they confirm excellent overall outcomes and low toxicity. In the future, the integration of PROs paired with high-end treatment will further improve outcomes.<\/jats:p>","DOI":"10.3390\/cancers11121884","type":"journal-article","created":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T11:07:00Z","timestamp":1574852820000},"page":"1884","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patient-Reported Outcome (PRO) as an Addition to Long-Term Results after High-Precision Stereotactic Radiotherapy in Patients with Secreting and Non-Secreting Pituitary Adenomas: A Retrospective Cohort Study up to 17-Years Follow-Up"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-8151","authenticated-orcid":false,"given":"Kerstin A.","family":"Kessel","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany"},{"name":"Institute of Radiation Medicine (IRM), Helmholtz Zentrum M\u00fcnchen, 85764 Neuherberg, Germany"},{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian D.","family":"Diehl","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Oechsner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6486-7955","authenticated-orcid":false,"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany"},{"name":"Department of Neurosurgery, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Gempt","sequence":"additional","affiliation":[{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany"},{"name":"Department of Neurosurgery, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany"},{"name":"Department of Neuroradiology, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friederike","family":"Schmidt-Graf","sequence":"additional","affiliation":[{"name":"Department of Neurology, Technical University of Munich (TUM), 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Technical University of Munich (TUM), 81675 Munich, Germany"},{"name":"Institute of Radiation Medicine (IRM), Helmholtz Zentrum M\u00fcnchen, 85764 Neuherberg, Germany"},{"name":"Deutsches Konsortium f\u00fcr Translationale Krebsforschung (DKTK), DKTK Partner Site, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/00005792-199907000-00004","article-title":"Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients","volume":"78","author":"Gsponer","year":"1999","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1530\/eje.1.02326","article-title":"Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry","volume":"156","author":"Saeger","year":"2007","journal-title":"Eur. J. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ando.2015.04.003","article-title":"Post-surgical management of non-functioning pituitary adenoma","volume":"76","author":"Bonneville","year":"2015","journal-title":"Ann. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1210\/jc.2010-1048","article-title":"Pituitary incidentaloma: An endocrine society clinical practice guideline","volume":"96","author":"Freda","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s11060-013-1354-5","article-title":"Epidemiology and etiopathogenesis of pituitary adenomas","volume":"117","author":"Aflorei","year":"2014","journal-title":"J. Neuro Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s10194-008-0084-0","article-title":"Headache associated with pituitary tumors","volume":"10","author":"Gondim","year":"2009","journal-title":"J. Headache Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s11060-010-0302-x","article-title":"A prospective study of nonfunctioning pituitary adenomas: Presentation, management, and clinical outcome","volume":"102","author":"Chen","year":"2011","journal-title":"J. Neuro Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3089","DOI":"10.1210\/jc.2004-2231","article-title":"Clinical review: Diagnosis and management of pituitary carcinomas","volume":"90","author":"Kaltsas","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s10143-010-0285-2","article-title":"Treatment of pituitary adenomas using radiosurgery and radiotherapy: A single center experience and review of literature","volume":"34","author":"Sun","year":"2010","journal-title":"Neurosurg. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1748-717X-8-18","article-title":"Long term toxicity and prognostic factors of radiation therapy for secreting and non-secreting pituitary adenomas","volume":"8","author":"Rieken","year":"2013","journal-title":"Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101299","DOI":"10.1016\/j.beem.2019.101299","article-title":"The optimal surgical techniques for pituitary tumors","volume":"33","author":"Buchfelder","year":"2019","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1056\/NEJMcp0912025","article-title":"Clinical practice. Prolactinomas","volume":"362","author":"Klibanski","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_13","first-page":"3419","article-title":"Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly","volume":"83","author":"Swearingen","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/B978-0-444-59602-4.00019-8","article-title":"Surgical approach to pituitary tumors","volume":"124","author":"Solari","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.hjdsi.2016.08.004","article-title":"Patient portals and health apps: Pitfalls, promises, and what one might learn from the other","volume":"5","author":"Baldwin","year":"2017","journal-title":"Healthcare"},{"key":"ref_16","first-page":"30","article-title":"Functioning Pituitary Adenomas\u2014Current Treatment Options and Emerging Medical Therapies","volume":"15","author":"Varlamov","year":"2019","journal-title":"Eur. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3171\/2012.7.GKS12783","article-title":"Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma","volume":"117","author":"Sun","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00066-007-1706-1","article-title":"Long-term follow-up of patients with pituitary macroadenomas after postoperative radiation therapy: Analysis of tumor control and functional outcome","volume":"183","author":"Langsenlehner","year":"2007","journal-title":"Strahlenther. Onkol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e1291","DOI":"10.1016\/j.wneu.2018.11.038","article-title":"Long-Term Efficacy and Tolerability of Gamma Knife Radiosurgery for Growth Hormone-Secreting Adenoma: A Retrospective Multicenter Study (MERGE-001)","volume":"122","author":"Kong","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/1748-717X-6-169","article-title":"Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma","volume":"6","author":"Weber","year":"2011","journal-title":"Radiat. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.semradonc.2015.11.008","article-title":"Dose-Response Modeling of the Visual Pathway Tolerance to Single-Fraction and Hypofractionated Stereotactic Radiosurgery","volume":"26","author":"Hiniker","year":"2016","journal-title":"Semin. Radiat. Oncol."},{"key":"ref_22","unstructured":"Cordeiro, D., Xu, Z., Mehta, G.U., Ding, D., Vance, M.L., Kano, H., Sisterson, N., Yang, H.C., Kondziolka, D., and Lunsford, L.D. (2018). Hypopituitarism after Gamma Knife radiosurgery for pituitary adenomas: A multicenter, international study. J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sun, S., Liu, A., and Zhang, Y. (2019). Long-Term Follow-Up Studies of Gamma Knife Radiosurgery for Postsurgical Nonfunctioning Pituitary Adenomas. World Neurosurg.","DOI":"10.1016\/j.wneu.2019.01.009"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1210\/jc.2007-1220","article-title":"Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas","volume":"93","author":"Petit","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.ijrobp.2014.06.068","article-title":"Outcomes of proton therapy for patients with functional pituitary adenomas","volume":"90","author":"Wattson","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.ijrobp.2005.07.978","article-title":"Fractionated proton beam irradiation of pituitary adenomas","volume":"64","author":"Ronson","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00066-017-1156-3","article-title":"High-precision radiotherapy for meningiomas: Long-term results and patient-reported outcome (PRO)","volume":"193","author":"Kessel","year":"2017","journal-title":"Strahlenther. Onkol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s00066-016-1070-0","article-title":"Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma: Hearing preservation and patients\u2019 self-reported outcome based on an established questionnaire","volume":"193","author":"Kessel","year":"2017","journal-title":"Strahlenther. Onkol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.2196\/mhealth.9486","article-title":"Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study","volume":"6","author":"Kessel","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.2196\/mhealth.7689","article-title":"Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care","volume":"5","author":"Kessel","year":"2017","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e312","DOI":"10.2196\/jmir.6399","article-title":"Mobile Apps in Oncology: A Survey on Health Care Professionals\u2019 Attitude Toward Telemedicine, mHealth, and Oncological Apps","volume":"18","author":"Kessel","year":"2016","journal-title":"J. Med. Internet Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0090-3019(00)00171-3","article-title":"Pituitary adenomas: Results of 684 surgically treated patients and review of the literature","volume":"53","author":"Oruckaptan","year":"2000","journal-title":"Surg. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1023\/A:1006477905230","article-title":"Postoperative radiation therapy for pituitary adenoma","volume":"48","author":"Isobe","year":"2000","journal-title":"J. Neuro Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/j.ijrobp.2007.01.017","article-title":"Radiotherapy is not associated with reduced quality of life and cognitive function in patients treated for nonfunctioning pituitary adenoma","volume":"68","author":"Keers","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hung, Y.C., Lee, C.C., Yang, H.C., Mohammed, N., Kearns, K.N., Nabeel, A.M., Abdel Karim, K., Emad Eldin, R.M., El-Shehaby, A.M.N., and Reda, W.A. (2019). The benefit and risk of stereotactic radiosurgery for prolactinomas: An international multicenter cohort study. J. Neurosurg.","DOI":"10.3171\/2019.4.JNS183443"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"390","DOI":"10.3171\/sup.2004.101.supplement3.0390","article-title":"Dose fractionation in stereotactic radiotherapy for parasellar meningiomas: Radiobiological considerations of efficacy and optic nerve tolerance","volume":"101","author":"Shrieve","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"936","DOI":"10.4065\/73.10.936","article-title":"Primarily resected meningiomas: Outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988","volume":"73","author":"Stafford","year":"1998","journal-title":"Mayo Clin. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"20190170","DOI":"10.1259\/bjr.20190170","article-title":"Physiological motion of the optic chiasm and its impact on stereotactic radiosurgery dose","volume":"92","author":"Xiang","year":"2019","journal-title":"Br. J. Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Denis, F., Lethrosne, C., Pourel, N., Molinier, O., Pointreau, Y., Domont, J., Bourgeois, H., Senellart, H., Tremolieres, P., and Lizee, T. (2017). Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J. Natl. Cancer Inst., 109.","DOI":"10.1093\/jnci\/djx029"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.1007\/s00520-016-3297-9","article-title":"The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): A systematic review","volume":"24","author":"Atkinson","year":"2016","journal-title":"Supportive Care Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.radonc.2014.07.008","article-title":"Investigation of a Patient Reported Outcome tool to assess radiotherapy-related toxicity prospectively in patients with lung cancer","volume":"112","author":"Christodoulou","year":"2014","journal-title":"Radiother. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"dju244","DOI":"10.1093\/jnci\/dju244","article-title":"Development of the National Cancer Institute\u2019s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)","volume":"106","author":"Basch","year":"2014","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1001\/jamaoncol.2015.2639","article-title":"Validity and Reliability of the US National Cancer Institute\u2019s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)","volume":"1","author":"Dueck","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3389\/fendo.2019.00588","article-title":"Machine Learning-Based Radiomics Predicts Radiotherapeutic Response in Patients With Acromegaly","volume":"10","author":"Fan","year":"2019","journal-title":"Front. Endocrinol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/11\/12\/1884\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:37:55Z","timestamp":1760189875000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/11\/12\/1884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,27]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["cancers11121884"],"URL":"https:\/\/doi.org\/10.3390\/cancers11121884","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2019,11,27]]}}}