Wan Heng, Chihiro Ohye, Yuan Shubin
Department of Neurology and Functional neurosurgery, West China Fourth Hospital, Sichuan University, Chengdu, 610041, PR China.
J Exp Clin Cancer Res. 2009 Mar 11;28(1):36. doi: 10.1186/1756-9966-28-36.
Secretory pituitary adenomas are very common brain tumors. Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, and fractionated radiotherapy. In recent years, MASEP gamma knife radiosurgery (MASEP GKRS) has emerged as an important treatment modality in the management of secretory pituitary adenomas. The goal of this research is to define accurately the efficacy, safety, complications, and role of MASEP GKRS for treatment of secretory pituitary adenomas.
Between 1997 and 2007 a total of 347 patients with secretory pituitary adenomas treated with MASEP GKRS and with at least 60 months of follow-up data were identified. In 47 of these patients some form of prior treatment such as transsphenoidal resection, or craniotomy and resection had been conducted. The others were deemed ineligible for microsurgery because of body health or private choice, and MASEP GKRS served as the primary treatment modality. Endocrinological, ophthalmological, and neuroradiological responses were evaluated.
MASEP GKRS was tolerated well in these patients under the follow-up period ranged from 60 to 90 months; acute radioreaction was rare and 17 patients had transient headaches with no clinical significance. Late radioreaction was noted in 1 patient and consisted of consistent headache. Of the 68 patients with adrenocorticotropic hormone-secreting(ACTH) adenomas, 89.7% showed tumor volume decrease or remain unchanged and 27.9% experienced normalization of hormone level. Of the 176 patients with prolactinomas, 23.3% had normalization of hormone level and 90.3% showed tumor volume decrease or remain unchanged. Of the 103 patients with growth hormone-secreting(GH) adenomas, 95.1% experienced tumor volume decrease or remain unchanged and 36.9% showed normalization of hormone level.
MASEP GKRS is safe and effective in treating secretory pituitary adenomas. None of the patients in our study experienced injury to the optic apparatus or had other neuropathies related with gamma knife. MASEP GKRS may serve as a primary treatment method in some or as a salvage treatment in the others. However, treatment must be tailored to meet the patient's symptoms, tumor location, tumor morphometry, and overall health. Longer follow-up is required for a more complete assessment of late radioreaction and treatment efficacy.
分泌性垂体腺瘤是非常常见的脑肿瘤。从历史上看，分泌性垂体腺瘤的治疗手段包括神经外科手术、药物治疗和分次放射治疗。近年来，多靶点立体定向伽玛刀放射外科治疗（MASEP GKRS）已成为分泌性垂体腺瘤治疗中的一种重要治疗方式。本研究的目的是准确界定MASEP GKRS治疗分泌性垂体腺瘤的疗效、安全性、并发症及作用。
1997年至2007年间，共确定了347例接受MASEP GKRS治疗且有至少60个月随访数据的分泌性垂体腺瘤患者。其中47例患者曾接受过某种形式的先前治疗，如经蝶窦切除术或开颅切除术。其他患者因身体健康或个人选择被认为不适合显微手术，MASEP GKRS作为主要治疗方式。评估了内分泌、眼科和神经放射学反应。
在随访期60至90个月期间，这些患者对MASEP GKRS耐受性良好；急性放射反应罕见，17例患者出现短暂头痛，无临床意义。1例患者出现晚期放射反应，表现为持续性头痛。在68例促肾上腺皮质激素（ACTH）分泌型腺瘤患者中，89.7%的患者肿瘤体积减小或保持不变，27.9%的患者激素水平恢复正常。在176例泌乳素瘤患者中，23.3%的患者激素水平恢复正常，90.3%的患者肿瘤体积减小或保持不变。在103例生长激素（GH）分泌型腺瘤患者中，95.1%的患者肿瘤体积减小或保持不变，36.9%的患者激素水平恢复正常。
MASEP GKRS治疗分泌性垂体腺瘤安全有效。我们研究中的患者均未出现视器损伤或与伽玛刀相关的其他神经病变。MASEP GKRS在某些患者中可作为主要治疗方法，在其他患者中可作为挽救性治疗方法。然而，治疗必须根据患者的症状、肿瘤位置、肿瘤形态学和整体健康状况进行调整。需要更长时间的随访以更全面地评估晚期放射反应和治疗效果。
