Department of Radiation Oncology, Geneva University Hospital, 1211 Geneva, Switzerland.
Radiat Oncol. 2011 Dec 8;6:169. doi: 10.1186/1748-717X-6-169.
To evaluate the efficacy and toxicity of stereotactic fractionated radiotherapy (SFRT) for patients with pituitary macroadenoma (PMA).
Between March 2000 and March 2009, 27 patients (male to female ratio, 1.25) with PMA underwent SFRT (median dose, 50.4 Gy). Mean age of the patients was 56.5 years (range, 20.3 - 77.4). In all but one patient, SFRT was administered for salvage treatment after surgical resection (transphenoidal resection in 23, transphenoidal resection followed by craniotomy in 2 and multiple transphenoidal resections in another patient). In 10 (37%) patients, the PMAs were functional (3 ACTH-secreting, 3 prolactinomas, 2 growth hormone-secreting and 2 multiple hormone-secretion). Three (11.1%) and 9 (33.3%) patients had PMA abutting and compressing the optic chiasm, respectively. Mean tumor volume was 2.9 ± 4.6 cm3. Eighteen (66.7%) patients had hypopituitarism prior to SFRT. The mean follow-up period after SFRT was 72.4 ± 37.2 months.
Tumor size decreased for 6 (22.2%) patients and remained unchanged for 19 (70.4%) other patients. Two (7.4%) patients had tumor growth inside the prescribed treatment volume. The estimated 5-year tumor growth control was 95.5% after SFRT. Biochemical remission occurred in 3 (30%) patients with functional PMA. Two patients with normal anterior pituitary function before SFRT developed new deficits 25 and 65 months after treatment. The 5-year survival without new anterior pituitary deficit was thus 95.8%. Five patients with visual field defect had improved visual function and 1 patient with no visual defect prior to SFRT, but an optic chiasm abutting tumor, had a decline in visual function. The estimated 5-year vision and pituitary function preservation rates were 93.2% and 95.8%, respectively.
SFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1 patient with visual field defect out of two had an improved visual function.
评估立体定向分割放疗（SFRT）治疗垂体大腺瘤（PMA）患者的疗效和毒性。
2000 年 3 月至 2009 年 3 月期间，27 例 PMA 患者（男/女比例为 1.25）接受 SFRT（中位剂量 50.4Gy）。患者平均年龄为 56.5 岁（范围 20.3-77.4）。除 1 例患者外，SFRT 均为手术切除后的挽救治疗（经蝶窦切除术 23 例，经蝶窦切除术加开颅术 2 例，多次经蝶窦切除术 1 例）。10 例（37%）患者的 PMAs 具有功能性（3 例 ACTH 分泌，3 例泌乳素瘤，2 例生长激素分泌，2 例多种激素分泌）。3 例（11.1%）和 9 例（33.3%）患者的 PMA 分别紧贴和压迫视交叉。肿瘤平均体积为 2.9±4.6cm3。18 例（66.7%）患者在 SFRT 前存在垂体功能减退。SFRT 后平均随访时间为 72.4±37.2 个月。
6 例（22.2%）患者肿瘤缩小，19 例（70.4%）患者肿瘤大小不变。2 例（7.4%）患者肿瘤在规定治疗体积内生长。SFRT 后 5 年肿瘤生长控制率估计为 95.5%。3 例功能性 PMA 患者生化缓解。2 例 SFRT 前有正常前叶功能的患者在治疗后 25 个月和 65 个月时出现新的垂体功能减退。因此，5 年无新发垂体前叶功能减退的生存率为 95.8%。5 例视野缺损患者的视力功能改善，1 例无视野缺损但视交叉受压的患者视力下降。5 年视力和垂体功能保存率分别估计为 93.2%和 95.8%。
SFRT 是治疗 PMA 患者的一种安全有效的方法，尽管需要更长时间的随访来评估长期疗效。在这项研究中，大约每 2 例视野缺损患者中就有 1 例视力功能改善。
