Lower all-cause mortality rates in patients harboring pituitary carcinoma following the introduction of temozolomide Abstract Objective To evaluate the impact of temozolomide (TMZ) introduction on the survival of patients with pituitary carcinoma (PC) compared to aggressive pituitary adenoma (APA). Methods Retrospective analysis of the Surveillance Epidemiology and End-Results database (SEER), including patients diagnosed with PC or APA between 1973 and 2015. Age-adjusted Kaplan–Meier analyses were performed, comparing all-cause mortality (ACM) rates before the year 2006, the time of TMZ introduction (“period 1”), and afterwards (“period 2”), in patients harboring PC and APA. Results Among 107 patients, 18 (16.8%) harbored PC. The prevalence of PC and APA was comparable between genders, ethnicities and age strata. Patients harboring any pituitary tumor (PC or APA) had comparable risk for ACM and disease-specific mortality between the two time periods. However, among patients harboring PC, the risk for ACM was significantly lower in period 2 vs. period 1 (p = 0.021), becoming comparable to the risk of ACM in patients diagnosed with APA (p = 0.48). Conclusions In this large cancer-database-based analysis we observed improved overall survival in patients harboring PC in the years following the introduction of TMZ.