垂体腺瘤分次放疗后的长期结局：分泌性肿瘤的困扰
Long-term Outcome After Fractionated Radiotherapy for Pituitary Adenoma: The Curse of the Secretory Tumor.
作者信息
Scheick Stacey, Amdur Robert J, Kirwan Jessica M, Morris Christopher G, Mendenhall William M, Roper Steven, Friedman William
机构信息
Departments of *Radiation Oncology †Neurosurgery, College of Medicine, University of Florida, Gainesville, FL.
出版信息
Am J Clin Oncol. 2016 Feb;39(1):49-54. doi: 10.1097/COC.0000000000000014.
OBJECTIVES
To determine the influence of secretory status on long-term outcome after fractionated radiotherapy (RT) for gross residual pituitary adenoma.
MATERIALS AND METHODS
This is a retrospective study of 116 consecutively treated patients who met the following inclusion criteria: tissue diagnosis of pituitary adenoma, visible tumor at the time of RT, treatment with fractionated RT, and imaging follow-up of ≥2 years. Hypersecretion of growth hormone, adrenocorticotrophic hormone, prolactin, or thyroid-stimulating hormone was documented in 30 patients (26%). The RT dose in most (78%) patients was 45 Gy at 1.8 Gy per fraction. The major outcome endpoint is clinical and biochemical control, meaning no growth on follow-up scans and normalization of hypersecretion, if present before RT.
RESULTS
Long-term tumor control was outstanding for nonsecretory tumors: 96% at 10 years. There was a major drop in the control rate of secretory tumors: 10-year clinical and biochemical control was 62% (P<0.0001 vs. 96%). Multivariate analysis confirmed secretory status as the only independent prognostic factor (variables analyzed were sex, age, tumor size, RT dose, and secretory status).
CONCLUSIONS
Secretory pituitary adenomas have a worse prognosis than nonsecretory tumors after 45 to 50 Gy of conventionally fractionated RT. As a result of this finding, our plan is to increase the intensity of RT in secretory tumors, but our data did not evaluate this approach. The treatment guidelines that we currently use in pituitary adenoma are as follows. Radiosurgery (20 to 30 Gy) is our first-choice treatment of a secretory tumor that cannot be completely resected. When treating gross residual pituitary adenoma with fractionated RT, we use the following dose schedules: Nonsecretory: 45 Gy at 1.8 Gy/fraction, once-daily fractionation. Secretory: 54 Gy at 1.8 Gy/fraction once daily or 55.2 Gy at 1.2 Gy/fraction with twice-daily treatment.
目的
确定分泌状态对大残留垂体腺瘤分次放射治疗（RT）后长期预后的影响。
材料与方法
这是一项对116例连续治疗患者的回顾性研究，这些患者符合以下纳入标准：垂体腺瘤的组织诊断、放疗时可见肿瘤、分次放疗治疗以及≥2年的影像学随访。30例患者（26%）记录有生长激素、促肾上腺皮质激素、催乳素或促甲状腺激素分泌过多。大多数（78%）患者的放疗剂量为45 Gy，每次分割剂量为1.8 Gy。主要结局终点是临床和生化控制，即随访扫描时无肿瘤生长，且如果放疗前存在分泌过多，则分泌过多恢复正常。
结果
非分泌性肿瘤的长期肿瘤控制情况出色：10年时为96%。分泌性肿瘤的控制率大幅下降：10年临床和生化控制率为62%（与96%相比，P<0.0001）。多因素分析证实分泌状态是唯一的独立预后因素（分析的变量包括性别、年龄、肿瘤大小、放疗剂量和分泌状态）。
结论
在接受45至50 Gy常规分割放疗后，分泌性垂体腺瘤的预后比非分泌性肿瘤差。基于这一发现，我们计划增加分泌性肿瘤的放疗强度，但我们的数据未评估这种方法。我们目前用于垂体腺瘤的治疗指南如下。立体定向放射治疗（20至30 Gy）是我们对无法完全切除的分泌性肿瘤的首选治疗方法。用分次放疗治疗大残留垂体腺瘤时，我们采用以下剂量方案：非分泌性：45 Gy，每次分割剂量1.8 Gy，每日一次分割。分泌性：54 Gy，每次分割剂量1.8 Gy，每日一次，或55.2 Gy，每次分割剂量1.2 Gy，每日两次。
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