Radiotherapeutic management of pituitary adenomas and tumors of the hypothalamus requires a thorough understanding of the various hypersecretory syndromes and their wide spread clinical manifestations, a working knowledge of the diagnostic principles, and an appreciation for the roles of surgery and medical management. Treatment with external beam radiotherapy typically results in little radiographic change in the tumor itself, and endocrine changes may require years to become detectable or stabilized. Meaningful evaluation of pituitary or hypothalamic tumors requires long-term follow-up to assess response and to observe complications.

This chapter addresses the overall management of pituitary adenomas, craniopharyngiomas, hypothalamic tumors (including germ-cell neoplasms), parasellar meningiomas, and astrocytomas. This discussion emphasizes the role of and indications for radiotherapy. Standard external-beam techniques for radiotherapy are outlined, and less common techniques—such as intracavitary radioisotope instillation, brachytherapy, particle beam radiotherapy, and stereotactic radiosurgery—are discussed. The complications of conventional radiotherapy are also addressed.