Trans-sphenoidal hypophysectomy in the treatment of advanced breast cancer

Abstract

IN the past 15 years numerous papers have been published on the value of hypophysectomy in the treatment of metastatic breast cancer. In most cases the method employed was either a transfrontal craniotomy or transnasal isotope implantation. Since 1957 a number of reports have appeared describing the results of a trans-sphenoidal approach (Escher and Roth, 1957; Escher, Roth, and Cottier, 1958; Heck, McNaught, Dobson, and Greenspan, 1960; Escher and Ludi, 1961;Riskaer, Munthe Fog, and Hommelgaard, 1961;Noguera and Haase, 1961). All of these were based on a relatively small number of cases and none was from the United Kingdom. This paper presents the results of trans-sphenoidal hypophysectomy in a larger group of patients with advanced breast cancer who were followed for a longer postoperative period than in the other reported series. An evaluation was made of the indications for the operation and its effects discussed in relation to the results of previous treatment and to the likelihood of a favourable response following hypophysectomy . METHODS AND MATERIALThe pituitary gland was removed trans-sphenoidally by a technique the details of which have been described previously (Bateman, 1962). The patients, all women, had been referred by a number of surgeons and so the indications for surgery were necessarily variable. There was no preselection by the operator, the only criteria of acceptance being the patient's ability to withstand the operation, and whether the anatomy of the pituitary fossa and sphenoid sinus made the approach possible. The majority of patients had had previous surgery, radiotherapy, or hormone treatment. All patients treated with radioactive gold or yttrium were excluded. The assessment of the results was carried out by two independent observers. One of us (P. I. R.). personally assessed every patient who was alive during the last 2 years of the study and followed them up at regular, usually 3-monthlyY intervals following operation. Postoperative maintenance therapy with cortisone acetate and I-thyroxine in * Requests for reprints to P.