Prabhu Sujit S, Aldape Kenneth D, Gagel Robert F, Benjamin Robert S, Trent Jonathan C, McCutcheon Ian E
Department of Neurosurgery, Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Can J Neurol Sci. 2003 Nov;30(4):378-83. doi: 10.1017/s0317167100003115.
Although the benefits of radiotherapy for pituitary adenomas are well-documented, post-irradiation sarcomas of the sella are rarely seen, with only 20 cases (mainly of fibrosarcoma) reported in the medical literature.
We describe a case of post-irradiation sarcoma five years after surgery followed by external-beam irradiation for an extensive and locally invasive growth hormone-secreting tumor. The patient was subsequently given pegvisomant, an antagonist of growth hormone receptor, to control symptoms of growth hormone excess.
The patient underwent transsphenoidal resection of the recurrent tumor, followed by adjuvant chemotherapy. This led to significant relief in the patient's symptoms including radiological evidence of tumor shrinkage, but the tumor regrew when, owing to dose-limiting toxicity, chemotherapy was stopped.
Post-irradiation sarcomas of the pituitary are well-recognized but rare. They should be suspected in patients following sellar irradiation who show abrupt onset of new symptoms and appropriate radiological findings, and such tumors may respond to cytotoxic chemotherapy.
尽管放射治疗垂体腺瘤的益处已有充分文献记载，但鞍区放疗后肉瘤罕见，医学文献中仅报道了20例（主要为纤维肉瘤）。
我们描述了1例患者，其在接受手术及针对广泛且局部侵袭性生长激素分泌肿瘤的外照射放疗5年后发生放疗后肉瘤。该患者随后接受了生长激素受体拮抗剂培维索孟以控制生长激素过多症状。
患者接受了复发性肿瘤的经蝶窦切除术，随后进行辅助化疗。这使患者症状得到显著缓解，包括肿瘤缩小的影像学证据，但由于剂量限制性毒性而停止化疗后，肿瘤复发。
垂体放疗后肉瘤虽已得到充分认识但很罕见。对于接受鞍区放疗后出现新症状突然发作且有适当影像学表现的患者应怀疑有此类肿瘤，且此类肿瘤可能对细胞毒性化疗有反应。
