鞍区外原发性脑肿瘤患者接受颅部放射治疗后出现的下丘脑-垂体功能减退的时间过程。
Time course of hypothalamic-pituitary deficiency in adults receiving cranial radiotherapy for primary extrasellar brain tumors.
机构信息
Endocrinology Unit, Department of Internal Medicine, San Raffaele Scientific Institute, Milan, Italy.
出版信息
Radiother Oncol. 2011 Apr;99(1):23-8. doi: 10.1016/j.radonc.2011.02.015. Epub 2011 Mar 30.
BACKGROUND
No longitudinal data on hypothalamic-pituitary (HP) function are available in patients who had received cranial radiation therapy (CRT) for primary extrasellar brain tumors (PBT).
PURPOSE
To investigate the effects of CRT on HP function in adults with PBT.
PATIENTS AND METHODS
Twenty-six adults irradiated for PBT and six CRT naive controls were studied. CRT was delivered with 6 MV X-ray by a linear accelerator (2 Gy fraction schedule). Gross Tumor Volume (GTV) excluded the HP region that was contoured on the planning CT. Median dose to the HP region was 41.8 Gy (IQR: 30.7-49.8).
RESULTS
All controls maintained normal HP function. Hypopituitarism developed in 38% of CRT patients (GH deficiency 29%, ACTH 22%, TSH 14%, gonadotropin 4%, no abnormal prolactin level or diabetes insipidus). All HP failures occurred within 32 months after CRT.
CONCLUSIONS
Adults undergoing CRT for PBT are at increased risk for HP dysfunction within 3 years from CRT. Endocrine surveillance is recommended also in adults patients exposed to CRT for primary brain tumors distant from HP region.
背景
对于因原发性鞍旁脑肿瘤（PBT）而接受颅放射治疗（CRT）的患者，尚无关于下丘脑-垂体（HP）功能的纵向数据。
目的
研究 CRT 对 PBT 成人 HP 功能的影响。
患者和方法
研究了 26 名因 PBT 接受 CRT 治疗的成年人和 6 名 CRT 未治疗的对照组。CRT 采用直线加速器（2 Gy 分割方案）的 6 MV X 射线进行。大体肿瘤体积（GTV）排除了在计划 CT 上勾画的 HP 区域。HP 区域的中位剂量为 41.8 Gy（IQR：30.7-49.8）。
结果
所有对照组均保持 HP 功能正常。38%的 CRT 患者出现垂体功能减退（GH 缺乏 29%，ACTH 缺乏 22%，TSH 缺乏 14%，促性腺激素缺乏 4%，无异常催乳素水平或尿崩症）。所有 HP 衰竭均发生在 CRT 后 32 个月内。
结论
因 PBT 而接受 CRT 的成年人在 CRT 后 3 年内发生 HP 功能障碍的风险增加。建议对接受 CRT 治疗的原发性脑肿瘤远离 HP 区域的成年患者进行内分泌监测。
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