de Castro Douglas Guedes, Salvajoli João Victor, Canteras Miguel Montes, Cecílio Soraya A Jorge
Instituto de Radiocirurgia Neurológica, São Paulo, SP.
Arq Bras Endocrinol Metabol. 2006 Dec;50(6):996-1004. doi: 10.1590/s0004-27302006000600004.
Pituitary adenomas represent nearly 15% of all intracranial tumors. Multimodal treatment includes microsurgery, medical management and radiotherapy. Microsurgery is the primary recommendation for nonfunctioning and most of functioning adenomas, except for prolactinomas that are usually managed with dopamine agonist drugs. However, about 30% of patients require additional treatment after microsurgery for recurrent or residual tumors. In these cases, fractionated radiation therapy has been the traditional treatment. More recently, radiosurgery has been established as a treatment option. Radiosurgery allows the delivery of prescribed dose with high precision strictly to the target and spares the surrounding tissues. Therefore, the risks of hypopituitarism, visual damage and vasculopathy are significantly lower. Furthermore, the latency of the radiation response after radiosurgery is substantially shorter than that of fractionated radiotherapy. The goal of this review is to define the efficacy, safety and role of radiosurgery for treatment of pituitary adenomas and to present the preliminary results of our institution.
垂体腺瘤占所有颅内肿瘤的近15%。多模式治疗包括显微手术、药物治疗和放射治疗。显微手术是无功能腺瘤和大多数有功能腺瘤的主要推荐治疗方法,但泌乳素瘤通常采用多巴胺激动剂药物治疗。然而,约30%的患者在显微手术后因肿瘤复发或残留需要额外治疗。在这些情况下,分次放射治疗一直是传统的治疗方法。最近,放射外科已成为一种治疗选择。放射外科能够将规定剂量高精度地严格送达靶区,同时保护周围组织。因此,垂体功能减退、视觉损伤和血管病变的风险显著降低。此外,放射外科术后放射反应的潜伏期明显短于分次放射治疗。本综述的目的是确定放射外科治疗垂体腺瘤的疗效、安全性和作用,并展示我们机构的初步结果。