Besser G M, Burman P, Daly A F
Department of Endocrinology, St Bartholomew's Hospital, London, UK.
Eur J Endocrinol. 2005 Aug;153(2):187-93. doi: 10.1530/eje.1.01968.
Multimodal therapy for acromegaly affords adequate disease control for many patients; however, there remains a subset of individuals that exhibit treatment-resistant disease. The issue of treatment-resistant pituitary tumor growth remains relatively under-explored.
We assessed the literature for relevant data regarding the surgical, medical and radiotherapeutic treatment of acromegaly in order to identify the factors that were predictive of aggressive or treatment-resistant pituitary tumor behavior in acromegaly and undertook an assessment of the rates of failure to control tumor progression with available treatment modalities.
Young age at diagnosis, large tumor size, high growth hormone secretion and certain histological markers are predictors of future aggressive tumor behavior in acromegaly. Significant tumor regrowth occurs in less than 10% of cases thought to be cured surgically, whereas failure to control tumor growth is seen in less than 1% of patients receiving radiotherapy. Somatostatin analogs induce a variable degree of tumor shrinkage in acromegaly but up to 2.2% of somatostatin analog-treated tumors continue to grow. Relative to other therapies, limited data are available for pegvisomant, but these indicate that persistent tumor growth occurs in 1.6-2.9% of cases followed up regularly with serial magnetic resonance imaging scans.
Treatment-resistant tumor progression occurs in a small minority of patients with acromegaly, regardless of treatment modality. Young patients with large tumors or those with high pre-treatment levels of growth hormone particularly warrant close monitoring for continued tumor progression during treatment for acromegaly.
肢端肥大症的多模式治疗可为许多患者提供充分的疾病控制；然而，仍有一部分患者表现出对治疗耐药的疾病。对治疗耐药的垂体肿瘤生长问题仍相对未得到充分研究。
我们评估了有关肢端肥大症手术、药物和放射治疗的相关文献数据，以确定预测肢端肥大症中侵袭性或治疗耐药性垂体肿瘤行为的因素，并评估现有治疗方式控制肿瘤进展失败的发生率。
诊断时年龄小、肿瘤体积大、生长激素分泌高以及某些组织学标志物是肢端肥大症未来侵袭性肿瘤行为的预测因素。在被认为手术治愈的病例中，显著的肿瘤复发发生率不到10%，而接受放射治疗的患者中，肿瘤生长未得到控制的发生率不到1%。生长抑素类似物可使肢端肥大症肿瘤出现不同程度的缩小，但高达2.2%接受生长抑素类似物治疗的肿瘤仍继续生长。相对于其他疗法，培维索孟的相关数据有限，但这些数据表明，在定期进行系列磁共振成像扫描随访的病例中，1.6 - 2.9%出现持续性肿瘤生长。
无论采用何种治疗方式，肢端肥大症患者中一小部分会出现对治疗耐药的肿瘤进展。患有大肿瘤的年轻患者或治疗前生长激素水平高的患者在肢端肥大症治疗期间尤其需要密切监测肿瘤是否持续进展。
