Invasive pituitary adenomas and pituitary carcinomas are clinically indistinguishable until identification of metastases. Optimal management and survival outcomes for both are not clearly defined. The purpose of this study is to use the Surveillance, Epidemiology, and End Results (SEER) database to report patterns of care and compare survival outcomes in a large series of patients with invasive adenomas or pituitary carcinomas. One hundred seventeen patients diagnosed between 1973 and 2008 with pituitary adenomas/adenocarcinomas were included. Eighty-three invasive adenomas and seven pituitary carcinomas were analyzed for survival outcomes. Analyzed prognostic factors included age, sex, race, histology, tumor extent, and treatment. A significant decrease in survival was observed among carcinomas compared to invasive adenomas at 1, 2, and 5 years (p=0.047, 0.001, and 0.009). Only non-white race, male gender, and age ≥65 were significant negative prognostic factors for invasive adenomas (p=0.013, 0.033, and <0.001, respectively). There was no survival advantage to radiation therapy in treating adenomas at 5, 10, 20, or 30 years (p=0.778, 0.960, 0.236, and 0.971). In conclusion, pituitary carcinoma patients exhibit worse overall survival than invasive adenoma patients. This highlights the need for improved diagnostic methods for the sellar phase to allow for potentially more aggressive treatment approaches.

Purpose: To evaluate outcomes of proton therapy and x-ray radiation treatments for head and neck paragangliomas. Patients and Methods: Between 2004 and 2014, 13 patients with paragangliomas were treated with radiation using proton therapy (n ¼ 7) or x-ray modalities (n ¼ 6). Paragangliomas were jugular fossa, vagal, tympanic, and carotid body in 5, 4, 2, and 2 patients, respectively. Patients were treated definitively (n ¼ 8), for recurrence or progression after prior surgery (n ¼ 4), or for residual tumor after surgery (n ¼ 1). The median age was 55 years (range, 35 to 77 years). The median dose of proton therapy was 35 Gy (RBE) in 15 fractions, and 50.4 Gy in 28 fractions for those treated with xrays. Tumor volume was delineated at treatment planning and on follow-up images to assess volumetric changes over time. The median follow-up time after proton therapy was 52 months (range, 6 to 105 months) and 73 months (range, 37 to 91 months) after xray therapy. Results: No acute grade 3 or greater toxicities occurred. After radiation therapy, tumor control was maintained and performance status was unchanged or improved in all patients. Of the patients, 10 had stable findings, 2 had improvement in preexisting cranial nerve deficits, and 1 had progression of previously intermittent vocal cord paresis to paralysis, compensated by vocal-fold injection. No secondary malignancies have been observed. Volumetric tumor response assessment found 1 patient with an increase in tumor volume of 0.4 cm 3 at first postradiation assessment, followed by 6 years of stable tumor size. The remaining 12 patients had reduction in tumor volume over time with a median tumor volume reduction of 33% at the last follow-up. The median tumor regression slope for the proton cohort was À1.21 cm 3 /y compared with À0.27 cm 3 /y in the x-ray cohort (P ¼ .02). Conclusion: Both proton and x-ray radiation were effective in treating paraganglioma and had minimal acute side effects and few long-term complications.

Purpose: To perform a dosimetric comparison of 3 accelerated partial breast irradiation techniques: catheter-based brachytherapy (BT), intensity-modulated radiation therapy (IMRT), and proton beam therapy (PBT). Patients and Methods: Twelve patients with left-sided breast cancer treated with SAVI (Strut-Adjusted Volume Implant) were selected in this study. The original BT plans were compared with optimum plans using IMRT and PBT for 34 Gy (RBE) with 1.1 RBE in 10 fractions using identical parameters for target and organs at risk. Results: Significant reduction in maximum dose to the ipsilateral breast was observed with PBT and IMRT (mean 108.58% [PBT] versus 107.78% [IMRT] versus 2194.43% [BT], P ¼ .001 for both PBT and IMRT compared to BT). The mean dose to the heart was 0%, 1.38%, and 3.85%, for PBT, IMRT, and BT, respectively (P , .001 and P ¼ .026). The chest wall mean dose was 10.07%, 14.65%, and 29.44% for PBT, IMRT, and BT, respectively (P ¼ .001 and .013 compared to BT). The PBT was superior in reducing the mean ipsilateral lung dose (mean 0.04% versus 2.13% versus 5.4%, P ¼ .025 and P , .001). There was no statistically significant difference in the maximum dose to the ipsilateral lung, chest wall, 3-mm skin rind or in the mean ipsilateral breast V 50% among the 3 techniques (P ¼ .168, .405, .067, and .780, respectively). PBT exhibited the greatest mean dose homogeneity index of 4.75 compared to 7.18 for IMRT (P ¼ .001) and 195.82 for BT (P , .001). All techniques resulted in similar dose conformality (P ¼ .143). Conclusion: This study confirms the dosimetric feasibility of PBT and IMRT to lower dose to organs at risk while still maintaining high target dose conformality. Though the results of this comparison are promising, continued clinical research is needed to better define the role of PBT and IMRT in the accelerated partial breast irradiation treatment of early-stage breast cancer.

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