Department of Neurosurgery, Osaka City General Hospital, 2-13-22, Miyakojima-hondohri, Miyakojima-ku, Osaka 534-0021, Japan.
J Clin Neurosci. 2010 Mar;17(3):299-304. doi: 10.1016/j.jocn.2009.05.040. Epub 2010 Jan 13.
We evaluated the endocrinological outcomes of gamma knife radiosurgery (GKS) for the treatment of growth hormone (GH)-producing pituitary adenomas. Twenty-six patients treated with GKS (median treatment [tumour] volume: 0.8 mL; median marginal radiation dose: 20Gy) were followed for a median of 84 months. "Disease remission" was defined as either nadir levels of GH <1 microg/L during an oral glucose load, or random GH levels <2 microg/L and normal age-adjusted and sex-adjusted levels of insulin-like growth factor without pituitary suppressive medications. The remission rate was 38% (10/26) and the 5-year and 10-year actuarial remission rates were 16.9% and 47.4%, respectively. Two patients (8%) suffered hypopituitarism requiring medication, but no other serious deficits were observed. Although GKS requires a relatively long time to achieve hormonal remission, it is a very useful, long-term treatment for GH-producing adenomas. We propose that compared to continuing life-long medication, GKS is less invasive and more cost effective.
我们评估了伽玛刀放射外科治疗生长激素（GH）分泌型垂体腺瘤的内分泌学结果。26 例接受伽玛刀治疗（中位治疗[肿瘤]体积：0.8 毫升；中位边缘照射剂量：20Gy）的患者随访中位数为 84 个月。“疾病缓解”定义为口服葡萄糖负荷时 GH 最低水平<1μg/L，或随机 GH 水平<2μg/L 且胰岛素样生长因子水平正常，年龄和性别校正，无需垂体抑制药物。缓解率为 38%（10/26），5 年和 10 年的实际缓解率分别为 16.9%和 47.4%。2 例患者（8%）发生需要药物治疗的垂体功能减退，但未观察到其他严重缺陷。虽然伽玛刀放射外科治疗需要相对较长的时间才能达到激素缓解，但它是一种非常有用的 GH 分泌型腺瘤的长期治疗方法。我们提出，与终身药物治疗相比，伽玛刀放射外科治疗侵袭性更小，更具成本效益。
