Minniti G, Traish D, Ashley S, Gonsalves A, Brada M
Neuro-Oncology Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
Clin Endocrinol (Oxf). 2006 May;64(5):542-8. doi: 10.1111/j.1365-2265.2006.02506.x.
To assess the medium-term outcome in a cohort of patients with residual or recurrent pituitary adenoma treated with fractionated stereotactic conformal radiotherapy (SCRT).
Ninety-two patients (median age 50 years) with a residual or recurrent nonfunctioning (67) or a secreting (25) pituitary adenoma were treated between 1995 and 2003. Eighteen patients had a GH-secreting, five PRL-secreting and two an ACTH-secreting pituitary adenoma. Vision was impaired in 39 patients, with visual field deficit (35) and/or reduced visual acuity (25). Sixty-four patients had partial or complete hypopituitarism before SCRT. The treatment was delivered stereotactically by four noncoplanar conformal fixed fields using a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions.
At a median follow-up of 32 months (range 4-108) the 1, 3 and 5 years actuarial progression-free survival is 99%, 98% and 98%, and overall survival is 98%. Three patients recurred 5 months, 1 year and 9 years after SCRT requiring surgery. In secreting adenomas, hormone levels declined progressively, becoming normal in more than a third of patients with GH-secreting and PRL-secreting pituitary tumours. 50% of baseline GH level was achieved in just under 2 years. The treatment was well tolerated with minimal acute toxicity. Hypopituitarism was the most common long-term effect; 22% of patients had worsening of pituitary function. One patient developed unilateral quadrantopia without tumour progression.
SCRT as a high-precision technique of localized irradiation achieves tumour and hormone control of pituitary adenomas comparable with previously published data on the efficacy of conventional radiotherapy. Despite the potential advantage of reducing the volume of normal brain irradiated, the theoretical benefit over conventional radiotherapy in terms of the reduction in long-term morbidity has not yet been demonstrated and requires longer follow-up. Potential effect on long-term cognitive function has not been tested.
评估一组接受分次立体定向适形放疗（SCRT）治疗的残留或复发性垂体腺瘤患者的中期结局。
1995年至2003年间，对92例患者（中位年龄50岁）进行了治疗，这些患者患有残留或复发性无功能垂体腺瘤（67例）或分泌性垂体腺瘤（25例）。18例患者为生长激素分泌型垂体腺瘤，5例为泌乳素分泌型垂体腺瘤，2例为促肾上腺皮质激素分泌型垂体腺瘤。39例患者存在视力损害，伴有视野缺损（35例）和/或视力下降（25例）。64例患者在SCRT前存在部分或完全垂体功能减退。使用6兆伏直线加速器通过四个非共面适形固定野进行立体定向治疗，剂量为45 Gy，分25次给予。
中位随访32个月（范围4 - 108个月）时，1年、3年和5年的精算无进展生存率分别为99%、98%和98%，总生存率为98%。3例患者在SCRT后5个月、1年和9年复发，需要进行手术。在分泌性腺瘤中，激素水平逐渐下降，超过三分之一的生长激素分泌型和泌乳素分泌型垂体肿瘤患者激素水平恢复正常。不到2年时间内达到了基线生长激素水平的50%。该治疗耐受性良好，急性毒性极小。垂体功能减退是最常见的长期影响；22%的患者垂体功能恶化。1例患者出现单侧象限盲，无肿瘤进展。
SCRT作为一种高精度的局部照射技术，在垂体腺瘤的肿瘤和激素控制方面取得的效果与先前发表的关于传统放疗疗效的数据相当。尽管在减少正常脑照射体积方面具有潜在优势，但在降低长期发病率方面相对于传统放疗的理论益处尚未得到证实，需要更长时间的随访。对长期认知功能的潜在影响尚未进行测试。
