Department of Neurosurgery, Yale University School of Medicine and Yale-New Haven Medical Center, New Haven, Connecticut, USA.
Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Medical Center, New Haven, Connecticut, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):195-201. doi: 10.1016/j.wneu.2013.01.127. Epub 2013 Feb 4.
Single fraction stereotactic radiosurgery (SRS) is a common adjuvant therapy for hormonally active pituitary adenomas when surgical resection fails to control tumor growth or normalize hypersecretory activity. Marginal doses of 20-24 Gy are used at many centers and here we report our outcome data in patients treated with a higher marginal dose of 35 Gy.
Thirty-one patients with secretory pituitary adenomas (adrenocorticotropic hormone, n = 15; growth hormone, n = 13; prolactin, n = 2; thyroid-stimulating hormone, n = 1) were treated with 35 Gy to the 50% isodose line, and had a mean follow-up time of 40.2 months (range = 12-96). All patients were evaluated post-SRS for time to hormonal normalization, time to relapse, as well as incidence and time course of radiation-induced hypopituitarism and cranial neuropathies.
Initial normalization of hypersecretion was achieved in 22 patients (70%) with a median time to remission of 17.7 months. After initial hormonal remission, 7 patients (32%) experienced an endocrine relapse, with a mean time to relapse of 21 months. New endocrine deficiency within any of the five major hormonal axes occurred in 10 patients (32%). One patient (3%) developed new-onset unilateral optic nerve pallor within the temporal field 3 years after SRS. Three patients (10%) reported transient new or increasing frontal headaches of unclear etiology following their procedures.
Time to endocrine remission was more rapid in patients treated with 35 Gy, as compared to previously reported literature using marginal doses of 20-24 Gy. Rates of endocrine remission and relapse, post-SRS hypopituitarism, and radiation-induced sequelae were not increased following higher dose treatment.
对于手术切除未能控制肿瘤生长或使激素过度分泌活动正常化的激素活性垂体腺瘤，单次分割立体定向放射外科（SRS）是一种常见的辅助治疗方法。许多中心使用 20-24Gy 的边缘剂量，在此我们报告我们在使用更高边缘剂量 35Gy 治疗的患者中的结果数据。
31 例分泌性垂体腺瘤患者（促肾上腺皮质激素，n=15；生长激素，n=13；催乳素，n=2；促甲状腺激素，n=1）接受 35Gy 至 50%等剂量线，平均随访时间为 40.2 个月（范围为 12-96）。所有患者在 SRS 后均评估激素正常化时间、复发时间以及放射性垂体功能减退和颅神经病变的发生率和时间过程。
22 例（70%）患者在 17.7 个月的中位缓解时间内实现了过度分泌的初始正常化。在最初的激素缓解后，7 例（32%）患者发生内分泌复发，平均复发时间为 21 个月。在任何五个主要激素轴中都有 10 例（32%）患者出现新的内分泌不足。1 例（3%）患者在 SRS 后 3 年内出现单侧视神经苍白，位于颞区。3 例（10%）患者在手术后报告出现不明原因的短暂新发或加重的额头痛。
与使用 20-24Gy 边缘剂量的先前文献相比，接受 35Gy 治疗的患者达到内分泌缓解的时间更快。SRS 后内分泌缓解和复发、垂体功能减退和放射性后遗症的发生率并未因高剂量治疗而增加。
