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01-07-2007 | Review

Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques

Authors: Giuseppe Minniti, Marie-Lise Jaffrain-Rea, Mattia Osti, Giampaolo Cantore, Riccardo Maurizi Enrici

Published in: Neurosurgical Review | Issue 3/2007

Abstract

The initial management of nonfunctioning pituitary macroadenomas (NFAs) is usually surgery; however, a significant proportion of NFAs may require further treatment. Radiotherapy is currently used in patients with residual tumour and achieves excellent long-term control, but there are concerns about potential late toxicity. Stereotactic radiotherapy, both in the form of radiosurgery or fractionated stereotactic radiotherapy, has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. A review of the literature suggests that new radiation techniques offer safe and effective treatment for recurrent or residual pituitary adenomas; however longer follow-up is necessary to confirm the excellent tumour control and the potential reduction of long-term radiation toxicity. Currently, radiotherapy has an important role in patients with residual or progressive disease after surgery. Patients with small or no residual tumours after surgery may generally continue on a policy of surveillance without immediate irradiation, in order to avoid the potential toxicity of treatment.

Adler JR Jr, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59:244–254PubMedCrossRef

Al-Mefty O, Kersh JE, Routh A, Smith RR (1990) The long-term side effects of radiation therapy for benign brain tumours in adults. J Neurosurg 73:502–512PubMed

Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR (1994) Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab 79:348–354PubMedCrossRef

Bates AS, Bullivant B, Sheppard MC, Stewart PM (1999) Life expectancy following surgery for pituitary tumours. Clin Endocrinol (Oxf) 50:315–319CrossRef

Black PM, Zervas NT, Candia GL (1987) Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery 20:920–924PubMedCrossRef

Bliss P, Kerr GR, Gregor A (1994) Incidence of second brain tumours after pituitary irradiation in Edinburgh 1962–1990. Clin Oncol (R Coll Radiol) 6:361–363

Boelaert K, Gittoes NJ (2001) Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol 144:569–575PubMedCrossRef

Brada M, Rajan B, Traish D, Ashley S, Holmes-Sellors PJ, Nussey S, Uttley D (1993) The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 38:571–578

Brada M, Burchell L, Ashley S, Traish D (1999) The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys 45:693–698PubMedCrossRef

10.

Brada M, Ashley S, Ford D, Traish D, Burchell L, Rahan B (2002) Cerebrovascular mortality in patients with pituitary adenoma. Clin Endocrinol (Oxf) 57:713–717CrossRef

11.

Brada M, Ajithkumary TV, Minniti G (2004) Radiosurgery for pituitary adenomas. Clin Endocrinol (Oxf) 61:531–543CrossRef

12.

Bradley KJ, Wass JA, Turner HE (2003) Non-functioning pituitary adenomas with positive immunoreactivity for ACTH behave more aggressively than ACTH immunonegative tumours but do not recur more frequently. Clin Endocrinol (Oxf) 58:59–64CrossRef

13.

Bradley KM, Adams CB, Potter CP, Wheeler DW, Anslow PJ, Burke CW (1994) An audit of selected patients with non-functioning pituitary adenoma treated by transsphenoidal surgery without irradiation. Clin Endocrinol (Oxf) 41:655–659

14.

Breen P, Flickinger JC, Kondziolka D, Martinez AJ (1998) Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumour control. J Neurosurg 89:933–938PubMed

15.

Bulow B, Hagmar L, Mikoczy Z, Nordstrom C, Erfurth EM (1997) Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf) 46:75–78CrossRef

16.

Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J (1985) Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17:446–452PubMedCrossRef

17.

Coke C, Andrews DW, Corn BW, Werner-Wasik M, Downes B, McCune C, Curran WJ Jr (1997) Multiple fractionated stereotactic radiotherapy of residual pituitary macroadenomas: Initial experience. Stereotact Funct Neurosurg 69:183–190PubMedCrossRef

18.

Colin P, Jovenin N, Delemer B, Caron J, Grulet H, Hecart AC, Lukas C, Bazin A, Bernard MH, Scherpereel B, Peruzzi P, Nakib I, Redon C, Rousseaux P (2005) Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: A prospective study of 110 patients. Int J Radiat Oncol Biol Phys 62:333–341PubMedCrossRef

19.

Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J (1991) The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 15:860–866CrossRef

20.

Couldwell WT, Rosenow JM, Rovit RL, Benzil DL (2002) Hypophysopexy technique for radiosurgical treatment of cavernous sinus pituitary adenoma. Pituitary 5:169–173PubMedCrossRef

21.

Danoff BF, Cowchock FS, Marquette C, Mulgrew L, Kramer S (1982) Assessment of the long-term effects of primary radiation therapy for brain tumors in children. Cancer 49:1580–1586PubMedCrossRef

22.

Dekkers OM, Pereira AM, Roelfsema F, Voormolen JH, Neelis KJ, Schroijen MA, Smit JW, Romijn JA (2006) Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 91:1796–1801PubMedCrossRef

23.

Donahue B (1992) Short- and long-term complications of radiation therapy for pediatric brain tumors. Pediatr Neurosurg 18:207–217PubMedCrossRef

24.

Ebersold MJ, Quast LM, Laws ER Jr, Schithauer B, Randall RV (1986) Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64:713–719PubMed

25.

Erfurth EM, Bulow B, Mikoczy Z, Svahn-Tapper G, Hagmar L (2001) Is there an increase in second brain tumours after surgery and irradiation for a pituitary tumour? Clin Endocrinol 55:613–616CrossRef

26.

Erfurth EM, Bulow B, Svahn-Tapper G, Norrving B, Odh K, Mikoczy Z, Bjork J, Hagmar L (2002) Risk factors for cerebrovascular deaths in patients operated and irradiatied for pituitary tumours. J Clin Endocrinol Metab 87:4892–4899PubMedCrossRef

27.

Ferrante L, Trillo G, Ramundo E, Celli P, Jaffrain-Rea ML, Salvati M, Esposito V, Roperto R, Osti MF, Minniti G (2002) Surgical treatment of pituitary tumors in the elderly: clinical outcome and long-term follow-up. J Neurooncol 60:185–191PubMedCrossRef

28.

Fisher BJ, Gaspar LE, Noone B (1993) Radiation therapy of pituitary adenoma: Delayed sequelae. Radiology 187:843–846PubMed

29.

Fraioli B, Pastore FS, Signoretti S, De Caro GMF, Giuffré R (1999) The surgical treatment of pituitary adenomas in the eighth decade. Surg Neurol 51:261–267PubMedCrossRef

30.

Gittoes NJ, Bates AS, Tse W, Bullivant B, Sheppard MC, Clayton RN, Stewart PM (1998) Radiotherapy for non-function pituitary tumours. Clin Endocrinol (Oxf) 48:331–337CrossRef

31.

Greenman Y, Ouaknine G, Veshchev I, Reider-Groswasser II, Segev Y, Stern N (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: Markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 58:763–769CrossRef

32.

Grigsby PW, Simpson JR, Emami BN, Fineberg BB, Schwartz HG (1989) Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 16:1411–1417PubMed

33.

Guinan EM, Lowy C, Stanhope N, Lewis PD, Kopelman MD (1998) Cognitive effects of pituitary tumours and their treatments: Two case studies and an investigation of 90 patients. J Neurol Neurosurg Psychiatry 65:870–876PubMed

34.

Harris JR, Levene MB (1976) Visual complications following irradiation for pituitary adenomas and craniopharyngiomas. Radiology 120:167–171PubMed

35.

Hayashi M, Izawa M, Hiyama H, Nakamura S, Atsuchi S, Sato H, Nakaya K, Sasaki K, Ochai T, Kubo O, Hori T, Takakura K (1999) Gamma knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg 72:111–118PubMedCrossRef

36.

Ikeda H, Jokhura H, Yoshimoto T (1998) Gamma knife radiosurgery for pituitary adenomas: Usefulness of combined transphenoidal and gamma knife radiosurgery for adenomas invading the cavernous sinus. Radiat Oncol Investig 6:26–34PubMedCrossRef

37.

Intensity Modulated Radiation Therapy Collaborative Working Group (2001) Intensity-modulated radiotherapy: Current status and issues of interest. Int J Radiat Oncol Biol Phys 51:880–914CrossRef

38.

Iwai Y, Yamanaka K, Yoshioka K (2005) Radiosurgery for nonfunctioning pituitary adenomas. Neurosurgery 56:699–705PubMedCrossRef

39.

Izawa M, Hayashi M, Nakaya K, Satoh H, Otchiai T, Hori T, Takakura K (2000) Gamma knife radiosurgery for pituitary adenomas. J Neurosurg 93:19–22PubMed

40.

Jaffrain-Rea ML, Derome P, Bataini JP, Thomopoulos P, Bertagna X, Luton JP (1993) Influence of radiotherapy on long-term relapse in clinically non-secreting pituitary adenomas. A retrospective study (1970–1988). Eur J Med 2:398–403PubMed

41.

Jaffrain-Rea ML, Di Stefano D, Minniti G, Esposito V, Bultrini A, Ferretti E, Santoro A, Faticanti Scucchi L, Gulino A, Cantore G (2002) A critical reappraisal of MIB-1 labelling index significance in a large series of pituitary tumours: Secreting versus non-secreting adenomas. Endocr Relat Cancer 9:103–113PubMedCrossRef

42.

Jane JA Jr, Laws ER Jr (2001) The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg 193:651–659PubMedCrossRef

43.

Kajiwara K, Saito K, Yoshikawa K, Kato S, Akimura T, Nomura S, Ishihara H, Suzuki M (2005) Image-guided stereotactic radiosurgery with the CyberKnife for pituitary adenomas. Minim Invasive Neurosurg 48:91–96PubMedCrossRef

44.

Kline LB, Kim JY, Ceballos R (1985) Radiation optic neuropathy. Ophthalmology 92:1118–1126PubMed

45.

Kurosaki M, Ludecke DK, Flitsch J, Saeger W (2000) Surgical treatment of clinically nonsecreting pituitary adenomas in elderly patients. Neurosurgery 47:843–849PubMedCrossRef

46.

Leber KA, Bergloff J, Pendl G (1998) Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 88:43–50PubMedCrossRef

47.

Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, Ridgway EC (1998) Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery 43:432–438PubMedCrossRef

48.

Losa M, Valle M, Mortini P, Franzin A, da Passano CF, Cenzato M, Bianchi S, Picozzi P, Giovanelli M (2004) Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg 100:438–444PubMed

49.

Mackley HB, Reddy CA, Lee SY, Harnisch GA, Mayberg MR, Hamrahian AH, Suh JH (2007) Intensity-modulated radiotherapy for pituitary adenomas: the preliminary report of the Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 67:232–239PubMed

50.

Martinez R, Bravo G, Boraozo J, Rey G (1998) Pituitary rumours and gamma knife surgery. Clinical experience with more than 2 years of follow-up. Stereotact Funct Neurosurg 70:110–118PubMedCrossRef

51.

McCollough WM, Marcus RB Jr, Rhoton AL Jr, Ballinger WE, Million RR (1991) Long-term follow-up of radiotherapy for pituitary adenoma: The absence of late recurrence after greater than or equal to 4500 cGy. Int J Radiat Oncol Biol Phys 21:607–614PubMed

52.

McCord MW, Buatti JM, Fennell EM, Mendenhall WM, Marcus RB Jr, Rhoton AL, Grant MB, Friedman WA (1997) Radiotherapy for pituitary adenoma: Long-term outcome and sequelae. Int J Radiat Oncol Biol Phys 39:437–444PubMedCrossRef

53.

Meij BP, Lopes MB, Ellegala DB, Alden TD, Laws ER Jr (2002) The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg 96:195–208PubMedCrossRef

54.

Milker-Zabel S, Debus J, Thilmann C, Schegel W, Wannenmacher M (2001) Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and non-functional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys 50:1279–1286PubMedCrossRef

55.

Mingione V, Yen CP, Vance ML, Steiner M, Sheehan J, Laws ER, Steiner L (2006) Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:876–883PubMed

56.

Minniti G, Esposito V, Piccirilli M, Fratticci A, Santoro A, Jaffrain-Rea ML (2005) Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature. Eur J Endocrinol 153:723–735PubMedCrossRef

57.

Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: Update after an additional 10 years. J Clin Endocrinol Metab 90:800–804PubMedCrossRef

58.

Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2006) Fractionated stereotactic conformal radiotherapy for secreting and nonsecreting pituitary adenomas. Clin Endocrinol (Oxf) 64:542–548CrossRef

59.

Mitsumori M, Shrieve DC, Alexander E III, Kaiser UB, Richardson GE, Black PM, Loeffler JS (1998) Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys 42:573–580PubMedCrossRef

60.

Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz SC, Pendl G (1999) A 6-year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg 72:140–149PubMedCrossRef

61.

Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M (2005) Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 56:1222–1233PubMedCrossRef

62.

Nakabayashi H, Sunada I, Hara M (2001) Immunohistochemical analyses of cell cycle-related proteins, apoptosis, and proliferation in pituitary adenomas. J Histochem Cytochem 49:1193–1194PubMed

63.

Nishioka H, Hirano A, Haraoka J, Nakajima N (2002) Histological changes in the pituitary gland and adenomas following radiotherapy. Neuropathology 22:19–25PubMedCrossRef

64.

Nomikos P, Ladar C, Fahlbusch R, Buchfelder M (2004) Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas - a study on 721 patients. Acta Neurochir (Wien) 146:27–35CrossRef

65.

Paek SH, Downes MB, Bednarz G, Keane WM, Werner-Wasik M, Curran WJ Jr, Andrews DW (2005) Integration of surgery with fractionated stereotactic radiotherapy for treatment of nonfunctioning pituitary macroadenomas. Int J Radiat Oncol Biol Phys 61:795–808PubMedCrossRef

66.

Pan L, Zhang N, Wang E, Wang B, Xu W (1998) Pituitary adenomas: The effect of gamma knife radiosurgery on tumour growth and endocrinopathies. Stereotact Funct Neurosurg 70:119–126PubMedCrossRef

67.

Peace KA, Orme SM, Padayatty SJ, Godfrey HP, Belchetz PE (1998) Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication. Clin Endocrinol (Oxf) 49:391–396CrossRef

68.

Petrovitch Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML (2003) Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 53:51–59CrossRef

69.

Pirzkall A, Debus J, Haering P, Rhein B, Grosser KH, Hoss A, Wannenmacher M (2003) Intensity modulated radiotherapy (IMRT) for recurrent, residual, or untreated skull-base meningiomas: Preliminary clinical experience. Int J Radiat Oncol Biol Phys 55:362–372PubMedCrossRef

70.

Pollock BE, Carpenter PC (2003) Stereotactic radiosurgery as an alternative to fractionated radiotherapy for patients with recurrent or residual nonfunctioning pituitary adenomas. Neurosurgery 53:1086–1091PubMedCrossRef

71.

Powell M (1995) Recovery of vision following transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 9:367–373PubMedCrossRef

72.

Ron E, Modan B, Boice JD Jr, Alfandary E, Stovall M, Chetrit A, Katz L (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039PubMedCrossRef

73.

Rosen T, Bengtsson B (1990) Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 336:285–288PubMedCrossRef

74.

Rush S, Cooper PR (1997) Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macroadenomas. Int J Radiat Oncol Biol Phys 37:1031–1034PubMedCrossRef

75.

Saito K, Kuwayama A, Yamamoto N, Sugita K (1995) The transsphenoidal removal of nonfunctioning pituitary adenomas with suprasellar extensions: the open sella method and intentionally staged operation. Neurosurgery 36:668–675PubMedCrossRef

76.

Sasaki R, Murakami M, Okamoto Y, Kono K, Yoden E, Nakajima T, Nabeshima S, Kuroda Y (2000) The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys 47:1337–1345PubMedCrossRef

77.

Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for residual or recurrent non-functioning pituitary adenoma. J Neurosurg 93:738–742

78.

Snyder PJ (1993) Clinically nonfunctioning pituitary adenomas. Endocrinol Metab Clin North Am 22:163–175PubMed

79.

Sultanem K, Patrocinio H, Lambert C, Corns R, Leblanc R, Parker W, Shenouda G, Souhami L (2004) The use of hypofractionated intensity-modulated irradiation in the treatment of glioblastoma multiforme: Preliminary results of a prospective trial. Int J Radiat Oncol Biol Phys 58:247–252PubMedCrossRef

80.

Syndikus I, Tait D, Ashley S, Jannoun L (1994) Long-term follow-up of young children with brain tumors after irradiation. Int J Radiat Oncol Biol Phys 30:781–787PubMed

81.

Thapar K, Scheithauer BW, Kovacs K, Pernicone PJ, Laws ER Jr (1996) Expression in pituitary adenomas and carcinomas: Correlation with invasiveness and tumor growth fractions. Neurosurgery 38:765–770, p53PubMedCrossRef

82.

Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001) Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet 357:425–431PubMedCrossRef

83.

Trautmann JC, Laws ER Jr (1983) Visual status after transsphenoidal surgery at the Mayo Clinic, 1971–1982. Am J Ophthalmol 96:200–208PubMed

84.

Tsang RW, Laperriere NJ, Simpson WJ, Brierley J, Panzarella T, Smyth HS (1993) Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk. Cancer 72:2227–2233PubMedCrossRef

85.

Tsang RW, Brierly JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ (1994) Radiation therapy for pituitary adenoma: Treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 30:557–565PubMed

86.

Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - a follow-up study. Clin Endocrinol (Oxf) 51:281–284CrossRef

87.

Uy NW, Woo SY, Teh BS, Mai WY, Carpenter LS, Chiu JK, Lu HH, Gildenberg P, Trask T, Grant WH, Butler EB (2002) Intensity-modulated radiation therapy (IMRT) for meningioma. Int J Radiat Oncol Biol Phys 53:1265–1270PubMedCrossRef

88.

Vlahovitch B, Reynaud C, Rhiati J, Mansour H, Hammoud F (1988) Treatment and recurrences in 135 pituitary adenomas. Acta Neurochir Suppl (Wien) 42:120–123

89.

Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F (1999) Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin endocrinol Metab 84:3696–3700PubMedCrossRef

90.

Wilson CB (1997) Surgical management of pituitary tumors. J Clin Endocrinol Metab 82:2381–2385PubMedCrossRef

91.

Woollons AC, Hunn MK, Rajapakse YR, Hamilton DA, Conaglen JV, Balakrishnan V (2000) Non-functioning pituitary adenomas: Indications for postoperative radiotherapy. Clin endocrinol (Oxf) 53:713–717CrossRef

92.

Wowra B, Stummer W (2002) Efiicacy of gamma knife radiosurgery for non-functioning pituitary adenomas: A quantitative follow-up with magnetic resonance imaging-based volumetric analysis. J Neurosurg 97:429–443PubMed

93.

Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M (1995) External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33:307–314PubMedCrossRef

Title: Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques
Authors: Giuseppe Minniti
Marie-Lise Jaffrain-Rea
Mattia Osti
Giampaolo Cantore
Riccardo Maurizi Enrici
Publication date: 01-07-2007
Publisher: Springer-Verlag
Published in: Neurosurgical Review / Issue 3/2007
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-007-0072-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques

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Keynote webinar | Spotlight on medication adherence

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