Do you offer early adjuvant radiosurgery rather than waiting for progression in a patient with a residual non-functioning pituitary adenoma after resection?

Generally speaking, I would withhold adjuvant radiosurgery in a patient with residual nonfunctioning pituitary adenoma. Pituitary adenomas are exceptionally benign tumors with extremely low growth rates. Some studies have suggested that in the presence of residual tumor, close to two-thirds of patients will have no growth after 10 years of observation. On the other hand, radiosurgery carries with it a non-trivial risk of inducing new hormonal deficits. At 10 years, the risk of a new hormonal deficit is 90% or better. Therefore, so long as the patient has good serial follow-up with yearly to bi-yearly imaging, I will withhold radiosurgery until there are clear signs of progression, at which point I would consider either reoperation or radios...