Institute of Neurological Radiosurgery (IRCN), Alvorada street, 64, suit 13/14, São Paulo-SP, ZIP: 04550-000, Brazil.
Radiat Oncol. 2010 Nov 17;5:109. doi: 10.1186/1748-717X-5-109.
To assess the effects of radiosurgery (RS) on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas.
Retrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels) and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS.
The median follow-up was 42 months (6-109 months). The median dose was 12,5 Gy (9 - 15 Gy) and 20 Gy (12 - 28 Gy) for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42) of the cases and tumor shrinkage occurred in 10% (4 in 42) of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS.
RS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly acceptable radiological and hormonal control and absence of complications at this early follow-up are consistent with literature.
评估放射外科（RS）对垂体腺瘤患者的放射学和激素控制的影响及其毒性。
对 1999 年至 2008 年间采用伽玛刀治疗的 48 例连续垂体腺瘤患者中的 42 例进行回顾性分析，随访时间至少为 6 个月。RS 作为主要或辅助治疗。其中有 14 例无分泌性腺瘤，在功能性腺瘤中，9 例为催乳素瘤，9 例为促肾上腺皮质激素分泌瘤，10 例为生长激素分泌瘤。激素控制定义为激素反应（与 RS 前水平相比下降超过 50%）和激素正常化。放射学控制定义为肿瘤的静止或缩小。垂体功能减退和视觉缺陷是发病率的结果。垂体功能减退定义为开始任何激素替代治疗，视觉缺陷定义为 RS 后视力或视野丧失。
中位随访时间为 42 个月（6-109 个月）。无分泌性腺瘤和分泌性腺瘤的中位剂量分别为 12.5 Gy（9-15 Gy）和 20 Gy（12-28 Gy）。98%（41/42）的病例肿瘤生长得到控制，10%（4/42）的病例肿瘤缩小。3 年激素控制和正常化的累积率分别为 62.4%和 37.6%，5 年的累积率分别为 81.2%和 55.4%。激素控制和正常化的中位潜伏期分别为 15 个月和 18 个月。单因素分析显示，中位剂量或肿瘤体积与激素控制或正常化之间无相关性。无患者发生视觉缺陷，1 例患者发生 RS 后垂体功能减退。
RS 是治疗选定垂体腺瘤患者的有效且安全的治疗选择。放射反应的潜伏期短、影像学和激素控制率高、在早期随访中无并发症，这与文献一致。
Zotero 插件