Voges Juergen, Kocher Martin, Runge Matthias, Poggenborg Jorg, Lehrke Ralph, Lenartz Doris, Maarouf Mohammad, Gouni-Berthold Ioanna, Krone Wilhelm, Muller Rolf-Peter, Sturm Volker
Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
Cancer. 2006 Sep 15;107(6):1355-64. doi: 10.1002/cncr.22128.
A prospective study was conducted to assess the efficacy and side effects of linear accelerator (LINAC)-based radiosurgery (RS) performed with a reduced dose of therapeutic radiation for patients with surgically inaccessible pituitary macroadenomas.
From August 1990 through January 2004, 175 patients with pituitary macroadenomas were treated with LINAC-RS according to a prospective protocol. To minimize the risk for radiation-induced damage of the pituitary function, the therapeutic dose to be applied was limited to 20 grays.
Among 175 patients, 142 patients who had a minimum follow-up of 12 months (mean +/- standard deviation, 81.9 +/- 37.2 months) were included in the current study. The local tumor control rate was 96.5%, and the tumor response rate was 32.4%. The mean time (+/- standard deviation) from LINAC-RS to normalization of pathologic hormone secretion was 36.2 +/- 24.0 months. The probability for normalization was 34.3% at 3 years and 51.1% at 5 years. The frequency of endocrine cure (defined as the normalization of hormone secretion without specific medication intake) was 35.2% (mean +/- standard deviation time to cure, 42.1 +/- 25.0 months). Patients with Cushing disease had a statistically significant greater chance of achieving a cure (P = .001). Side effects of LINAC-RS were deterioration of anterior pituitary function (12.3%), radiation-induced tissue damage (2.8%), and radiation-induced neuropathy (1.4%).
LINAC-RS using a lower therapeutic radiation dose achieved local tumor control and normalization or cure of hormone secretion comparable to the results achieved with gamma-knife RS. Compared with the latter, the time to normalization or endocrine cure was delayed, most probably as a result of dose reduction. However, the lower therapeutic radiation dose did not prevent radiation-induced damage of pituitary function completely.
开展了一项前瞻性研究，以评估采用直线加速器（LINAC）的放射外科手术（RS）对手术难以触及的垂体大腺瘤患者减少治疗性辐射剂量时的疗效和副作用。
从1990年8月至2004年1月，根据前瞻性方案，对175例垂体大腺瘤患者进行了LINAC-RS治疗。为尽量降低辐射诱发垂体功能损伤的风险，应用的治疗剂量限制在20格雷。
175例患者中，本研究纳入了142例至少随访12个月（平均±标准差，81.9±37.2个月）的患者。局部肿瘤控制率为96.5%，肿瘤反应率为32.4%。从LINAC-RS到病理激素分泌恢复正常的平均时间（±标准差）为36.2±24.0个月。3年时恢复正常的概率为34.3%，5年时为51.1%。内分泌治愈（定义为无需特定药物治疗激素分泌恢复正常）的频率为35.2%（治愈的平均±标准差时间，42.1±25.0个月）。库欣病患者实现治愈的机会在统计学上显著更高（P = 0.001）。LINAC-RS的副作用为垂体前叶功能恶化（12.3%）、辐射诱发的组织损伤（2.8%）和辐射诱发的神经病变（1.4%）。
采用较低治疗性辐射剂量的LINAC-RS实现了局部肿瘤控制以及激素分泌恢复正常或治愈，与伽玛刀RS的结果相当。与后者相比，恢复正常或内分泌治愈的时间延迟，很可能是剂量降低的结果。然而，较低的治疗性辐射剂量并未完全防止辐射诱发的垂体功能损伤。
