Step-by-step Stereotactic Radiotherapy Planning of Pituitary Adenoma: A ROSE (Radiation Oncology from Simulation to Execution) Guide to Radiation Oncologists

Introduction Pituitary adenoma accounts for 10%–20% of all intracranial malignancies. The primary modality of treatment is surgery, while pituitary radiation is indicated in residual or recurrent setting post-surgery. Currently, stereotactic radiotherapy (SRT) is one of the main modalities of radiation treatment. The objective of this article is to describe the procedural steps for radiation planning of SRT of pituitary adenoma Methods The step-by-step procedure for stereotactic planning of pituitary adenoma has been described using a clinical scenario of pituitary adenoma. Results The stereotactic radiation planning of pituitary adenoma starts with the basic history and relevant clinical evaluation that is visual testing. Magnetic resonance imaging (MRI) of the brain is the imaging modality of choice. Evaluation of surgical notes and post-operative histopathology confirmation of diagnosis should also be done. The radiation planning of pituitary adenoma starts with Computed tomography (CT) simulation and MRI of brain that should be done in prescribed format to achieve uniformity in radiation planning. After CT and MRI image fusion, contouring of target, organs at risk (OAR) and radiation planning should be done. The plan evaluation includes target and OAR coverage index, conformity, homogeneity and gradient index and beam arrangement. After radiation plan evaluation, treatment is delivered after quality assurance and dry run. Conclusion The article highlights the sequential process of radiation planning for SRT—starting from simulation, planning, evaluation of plan and treatment.