Minniti Giuseppe, Jaffrain-Rea Marie-Lise, Osti Mattia, Cantore Giampaolo, Enrici Riccardo Maurizi
Department of Clinical Oncology, Neurooncology Unit, S Andrea Hospital, University La Sapienza, Rome, Italy.
Neurosurg Rev. 2007 Jul;30(3):167-75; discussion 175-6. doi: 10.1007/s10143-007-0072-x. Epub 2007 May 5.
The initial management of nonfunctioning pituitary macroadenomas (NFAs) is usually surgery; however, a significant proportion of NFAs may require further treatment. Radiotherapy is currently used in patients with residual tumour and achieves excellent long-term control, but there are concerns about potential late toxicity. Stereotactic radiotherapy, both in the form of radiosurgery or fractionated stereotactic radiotherapy, has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. A review of the literature suggests that new radiation techniques offer safe and effective treatment for recurrent or residual pituitary adenomas; however longer follow-up is necessary to confirm the excellent tumour control and the potential reduction of long-term radiation toxicity. Currently, radiotherapy has an important role in patients with residual or progressive disease after surgery. Patients with small or no residual tumours after surgery may generally continue on a policy of surveillance without immediate irradiation, in order to avoid the potential toxicity of treatment.
无功能垂体大腺瘤（NFAs）的初始治疗通常是手术；然而，相当一部分NFAs可能需要进一步治疗。放射治疗目前用于有残留肿瘤的患者，并能实现出色的长期控制，但人们担心其潜在的晚期毒性。立体定向放射治疗，无论是放射外科形式还是分次立体定向放射治疗，已发展成为一种更精确的照射技术，肿瘤定位更精准，因此减少了接受高辐射剂量照射的正常组织，尤其是脑的体积。文献综述表明，新的放射技术为复发性或残留性垂体腺瘤提供了安全有效的治疗；然而，需要更长时间的随访来证实出色的肿瘤控制以及潜在的长期放射毒性降低。目前，放射治疗在手术后有残留或疾病进展的患者中起着重要作用。手术后残留肿瘤小或无残留的患者通常可继续采取观察策略，不立即进行照射，以避免治疗的潜在毒性。
