Departments of Medical Endocrinology, Rigshospitalet, National University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Eur J Endocrinol. 2010 Apr;162(4):685-94. doi: 10.1530/EJE-09-1045. Epub 2010 Feb 4.
To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis.
Thirty-four patients (17 females, median 43 years (range 30-74)) with acromegaly were treated with FSRT (conformal dynamic arcing, dose 54 Gy, 27-30 fractions) between January 1998 and April 2007. Of the 34 patients, 32 had undergone transsphenoidal adenotomy, and 28 were on medical therapy before FSRT. Patients on medical therapy continued this during and after the irradiation. The treatment was gradually decreased/withdrawn after careful assessment.
Magnetic resonance scanning of the pituitary gland 34 months (median, range 11-95) after irradiation showed stable or reduced volume of the remaining tumour tissue in 31 of 34 patients (91%). Seventeen patients (50%) were biochemically controlled (normalised nadir GH during oral glucose tolerance test and IGF1 <+2 S.D.) 30 months after FSRT (median, range 6-60), and ten of them had true biochemical remission (off medical therapy) 30 months after FSRT (median, range 12-69). Of 28 patients with one or more functioning pituitary axes before irradiation, 8 (29%) developed further deficit of one or two pituitary axes 48 months (median, range 6-102) after FSRT. Of 34 patients, 20 still required medical treatment for acromegaly at the end of this study, mainly those with a short follow-up period after irradiation.
The FSRT seems promising in terms of treatment of acromegaly. Longer follow-up is, however, needed to assess the overall efficacy and safety of FSRT for acromegaly.
通过回顾性分析评价分割立体定向放射治疗（FSRT）在肢端肥大症中的疗效。
1998 年 1 月至 2007 年 4 月，34 例肢端肥大症患者（17 例女性，中位年龄 43 岁（范围 30-74 岁））接受 FSRT（适形动态弧形，剂量 54 Gy，27-30 次）。34 例患者中，32 例行经蝶窦腺瘤切除术，28 例在 FSRT 前接受药物治疗。FSRT 期间和之后，继续进行药物治疗。在仔细评估后，逐渐减少/停止治疗。
放疗后 34 个月（中位数，范围 11-95 个月）对垂体进行磁共振扫描，34 例患者中有 31 例（91%）剩余肿瘤组织体积稳定或缩小。17 例（50%）患者在 FSRT 后 30 个月生化控制良好（口服葡萄糖耐量试验时谷氨酰胺峰值正常，IGF1<+2 S.D.），其中 10 例在 FSRT 后 30 个月（中位数，范围 12-69）实现真正的生化缓解（停止药物治疗）。放疗前有 1 个或多个功能性垂体轴的 28 例患者中，8 例（29%）在 FSRT 后 48 个月（中位数，范围 6-102）出现 1 个或 2 个垂体轴进一步缺陷。34 例患者中，20 例在研究结束时仍需接受肢端肥大症的药物治疗，主要是那些在放疗后随访时间较短的患者。
FSRT 在肢端肥大症的治疗中具有很大的潜力。然而，需要更长的随访时间来评估 FSRT 治疗肢端肥大症的总体疗效和安全性。
