Department of Neurosurgery, Kantonsspital Aarau, Switzerland.
Acta Neurochir (Wien). 2010 Oct;152(10):1725-35. doi: 10.1007/s00701-010-0694-6. Epub 2010 May 30.
Secondary malignancies are infrequent sequelae of pituitary radiotherapy. The goal of the present case study is to analyze clinical features of a selected group of cases to define the special characteristics of these tumors. We report the illustrative case of a 38-year-old man with acromegaly who had transsphenoidal surgery and radiotherapy 7 years before presenting with a sellar high-grade sarcoma. Transsphenoidal and transcranial resection, as well as repeated gamma knife radiosurgery, could not prevent tumor progression and development of meningiosis sarcomatosa. We performed a thorough search of the literature and reviewed numerous publications and reports on primary and secondary sarcomas of the sella. Our search revealed 51 cases of mesenchymal malignancies after sellar radiotherapy. For further analysis, we identified and selected a group of patients based on the criteria for studying radiation-induced tumors as described by Cahan.Compared to the surgically treated group, secondary sarcomas of the sella are more frequent in patients who have had radiotherapy. These tumors occur at normal dose schedules with long latencies. Their growth is very aggressive and they may develop meningiosis sarcomatosa. Until now, no treatment modalities have been able to stop the progression of these neoplasms. Radiation-induced sarcoma is a rare sequela of pituitary radiotherapy. It is important for the treating physician to keep in mind the possibility of post-radiation sarcoma development. Additionally, one must include these tumors into the differential diagnosis in pituitary patients presenting with tumor recurrence more than 5 years after radiotherapy in combination with a secondary lack of hormonal activity.
继发恶性肿瘤是垂体放疗少见的后遗症。本病例研究的目的是分析一组选定病例的临床特征，以确定这些肿瘤的特殊特征。我们报告了一例 38 岁男性肢端肥大症患者的病例，该患者在出现鞍内高级别肉瘤之前曾接受过经蝶窦手术和放疗 7 年。经蝶窦和经颅切除术以及反复伽玛刀放射外科手术均无法阻止肿瘤进展和脑膜肉瘤病的发展。我们进行了全面的文献检索，查阅了大量关于鞍内原发性和继发性肉瘤的出版物和报告。我们的检索结果显示，有 51 例鞍内放疗后发生间充质恶性肿瘤。为了进一步分析，我们根据 Cahan 描述的研究放射性肿瘤的标准，确定并选择了一组患者。与手术治疗组相比，接受过放疗的患者更容易发生鞍内继发性肉瘤。这些肿瘤在正常剂量方案下发生，潜伏期较长。它们的生长非常侵袭性，可能发展为脑膜肉瘤病。到目前为止，还没有任何治疗方法能够阻止这些肿瘤的进展。放射性诱导肉瘤是垂体放疗罕见的后遗症。对于治疗医生来说，牢记放疗后发生肉瘤的可能性非常重要。此外，在接受过放疗 5 年以上的垂体瘤患者中，如果出现肿瘤复发并伴有继发性激素缺乏，必须将这些肿瘤纳入鉴别诊断。
