Sasaki R, Murakami M, Okamoto Y, Kono K, Yoden E, Nakajima T, Nabeshima S, Kuroda Y
Department of Radiology, Tenri Hospital, Nara, Japan.
Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1337-45. doi: 10.1016/s0360-3016(00)00503-4.
To evaluate the efficacy of conventional radiotherapy for reducing tumor size and endocrine hypersecretion of pituitary adenomas.
We reviewed the records of 91 patients with pituitary adenoma, who were first treated between 1969 and 1994 and had been followed for more than 2 years (median, 8.2 years.) Of these patients, 86 had received postoperative radiotherapy, and 5 had received radiotherapy alone. The median total dose was 51 Gy. Clinical symptoms related to mass effects or endocrine hypersecretion were assessed. The efficacy of radiotherapy was evaluated before treatment and during the follow-up period (1-14 years; median, 3 years) by estimating tumor size on computed tomography or magnetic resonance imaging in 56 patients, as well as by endocrine testing in the 22 patients who had secreting adenomas. Local control rate, prognostic factors, and side effects were analyzed.
Mass-effect symptoms improved in 72% and 79% of patients who had such symptoms due to nonsecreting adenomas and secreting adenomas, respectively. Symptoms of endocrine hypersecretion abated in 67% of patients who had such symptoms. Excessive hormone levels normalized in 74% of patients who showed endocrine hypersecretions. The greatest size reduction was seen 3 years after the completion of radiotherapy (24% CR, 62% PR, 12% NC, and 3% PD in nonsecreting adenomas, and 32% CR, 36% PR, 27% NC, and 5% PD in secreting adenomas). Three patients with secreting adenomas (2 with prolactinoma and 1 with Cushing's disease) showed a mismatch between reduction in tumor size and normalization of endocrine hypersecretion. The 10-year local control rates were 98%, 85%, 83%, and 67% for nonsecreting adenoma, growth-hormone-secreting adenoma, prolactinoma, and Cushing's disease, respectively. Univariate analyses showed that disease type and radiation field size were significant prognostic factors. Brain necrosis occurred in 1 patient who received a 60-Gy dose of irradiation.
We conclude that conventional external radiotherapy with 50 Gy is safe and sufficient to control pituitary adenoma. Careful observation is required in the management of secreting adenomas because the effects on tumor size and endocrine hypersecretion may be mismatched in some secreting adenomas.
评估传统放疗对缩小垂体腺瘤肿瘤大小及减少内分泌功能亢进的疗效。
我们回顾了91例垂体腺瘤患者的记录，这些患者于1969年至1994年间首次接受治疗，且随访时间超过2年（中位数为8.2年）。其中，86例患者接受了术后放疗，5例患者仅接受了放疗。总剂量中位数为51 Gy。评估了与占位效应或内分泌功能亢进相关的临床症状。在56例患者中，通过计算机断层扫描或磁共振成像评估肿瘤大小，并在22例分泌性腺瘤患者中进行内分泌检测，以此在治疗前及随访期（1至14年；中位数为3年）评估放疗效果。分析了局部控制率、预后因素及副作用。
因无分泌性腺瘤出现占位效应症状的患者中，72%的症状得到改善；因分泌性腺瘤出现占位效应症状的患者中，79%的症状得到改善。出现内分泌功能亢进症状的患者中，67%的症状减轻。出现内分泌功能亢进的患者中，74%的激素水平恢复正常。放疗结束后3年观察到肿瘤缩小最为明显（无分泌性腺瘤中，24%完全缓解，62%部分缓解，12%病情稳定，3%病情进展；分泌性腺瘤中，32%完全缓解，36%部分缓解，27%病情稳定，5%病情进展）。3例分泌性腺瘤患者（2例泌乳素瘤和1例库欣病）的肿瘤大小缩小与内分泌功能亢进恢复正常之间存在不一致情况。无分泌性腺瘤、生长激素分泌性腺瘤、泌乳素瘤和库欣病的10年局部控制率分别为98%、85%、83%和67%。单因素分析显示，疾病类型和放疗野大小是显著的预后因素。1例接受60 Gy照射剂量的患者发生了脑坏死。
我们得出结论，50 Gy的传统外照射放疗对于控制垂体腺瘤是安全且足够的。在分泌性腺瘤的治疗中需要仔细观察，因为在某些分泌性腺瘤中，放疗对肿瘤大小和内分泌功能亢进的影响可能不一致。
