Mackley Heath B, Reddy Chandana A, Lee Shih-Yuan, Harnisch Gayle A, Mayberg Marc R, Hamrahian Amir H, Suh John H
Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):232-9. doi: 10.1016/j.ijrobp.2006.08.039. Epub 2006 Nov 2.
Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of pituitary adenomas. However, there have been few published data on the short- and long-term outcomes of this treatment. This is the initial report of the Cleveland Clinic's experience.
Between February 1998 and December 2003, 34 patients with pituitary adenomas were treated with IMRT. A retrospective chart review was conducted for data analysis.
With a median follow-up of 42.5 months, the treatment has proven to be well tolerated, with performance status remaining stable in 90% of patients. Radiographic local control was 89%, and among patients with secretory tumors, 100% had a biochemical response. Only 1 patient required salvage surgery for progressive disease, giving a clinical progression free survival of 97%. The only patient who received more than 46 Gy experienced optic neuropathy 8 months after radiation. Smaller tumor volume significantly correlated with subjective improvements in nonvisual neurologic complaints (p = 0.03), and larger tumor volume significantly correlated with subjective worsening of visual symptoms (p = 0.05). New hormonal supplementation was required for 40% of patients. Younger patients were significantly more likely to require hormonal supplementation (p = 0.03).
Intensity-modulated radiation therapy is a safe and effective treatment for pituitary adenomas over the short term. Longer follow-up is necessary to determine if IMRT confers any advantage with respect to either tumor control or toxicity over conventional radiation modalities.
调强放射治疗（IMRT）越来越多地用于垂体腺瘤的治疗。然而，关于这种治疗的短期和长期结果的已发表数据很少。这是克利夫兰诊所经验的初步报告。
1998年2月至2003年12月期间，34例垂体腺瘤患者接受了IMRT治疗。进行回顾性病历审查以进行数据分析。
中位随访42.5个月，结果证明该治疗耐受性良好，90%的患者功能状态保持稳定。影像学局部控制率为89%，在分泌性肿瘤患者中，100%有生化反应。只有1例患者因疾病进展需要挽救性手术，临床无进展生存率为97%。唯一接受超过46 Gy照射的患者在放疗8个月后出现视神经病变。较小的肿瘤体积与非视觉神经症状的主观改善显著相关（p = 0.03），而较大的肿瘤体积与视觉症状的主观恶化显著相关（p = 0.05）。40%的患者需要新的激素补充治疗。年轻患者更有可能需要激素补充治疗（p = 0.03）。
调强放射治疗短期内是治疗垂体腺瘤的一种安全有效的方法。需要更长时间的随访来确定IMRT在肿瘤控制或毒性方面是否比传统放疗方式具有任何优势。
