gms | German Medical Science

Secondary malignancies are infrequent sequelae of pituitary radiotherapy. We will analyse the clinical features of a selected group of cases to define the characteristics of these tumors and give some suggestions for treatment.

We report the case of a 38-year-old man with acromegaly, who had surgery and conventional radiotherapy seven years before presenting with a high grade sarcoma of the sella. Transsphenoidal and transcranial resection, as well as gamma knife radiosurgery brought short lasting relief of symptoms but could not prevent tumor progression and development of meningiosis sarcomatosa. We performed a thorough search of the literature of studies on primary and secondary sarcomas of the sella. Our search revealed 51 cases of mesenchymal malignancies after sellar radiotherapy. For further analysis, a highly selected group of patients was formed, based on the criteria for studying radiation-induced tumors as described by Cahan.

Compared to the surgically treated group, secondary sarcomas of the sella are more frequent in irradiated patients. These tumors occur at normal dose schedules with long latencies after irradiation. Their growth is very aggressive and they may metastasize within the CNS. Until now modern treatment modalities have not been able to stop these neoplasms.

Radiation-induced sarcoma is a rare sequel of pituitary radiotherapy. It is important to know, however, the clinical features and to include these tumors in the differential diagnosis with pituitary patients presenting with tumor recurrence more than 5 years after radiotherapy in combination with a secondary lack of hormonal activity.