Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia; Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia.
Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):903-10. doi: 10.1016/j.ijrobp.2014.07.013. Epub 2014 Sep 9.
To investigate the safety and effectiveness of stereotactic radiosurgery (SRS) in patients with a silent corticotroph adenoma (SCA) compared with patients with other subtypes of non-adrenocorticotropic hormone staining nonfunctioning pituitary adenoma (NFA).
The clinical features and outcomes of 104 NFA patients treated with SRS in our center between September 1994 and August 2012 were evaluated. Among them, 34 consecutive patients with a confirmatory SCA were identified. A control group of 70 patients with other subtypes of NFA were selected for review based on comparable baseline features, including sex, age at the time of SRS, tumor size, margin radiation dose to the tumor, and duration of follow-up.
The median follow-up after SRS was 56 months (range, 6-200 months). No patients with an SCA developed Cushing disease during the follow-up. Tumor control was achieved in 21 of 34 patients (62%) in the SCA group, compared with 65 of 70 patients (93%) in the NFA group. The median progression-free survival (PFS) was 58 months in the SCA group. The actuarial PFS was 73%, 46%, and 31% in the SCA group and was 94%, 87%, and 87% in the NFA group at 3, 5, and 8 years, respectively. Silent corticotroph adenomas treated with a dose of ≥17 Gy exhibited improved PFS. New-onset loss of pituitary function developed in 10 patients (29%) in the SCA group, whereas it occurred in 18 patients (26%) in the NFA group. Eight patients (24%) in the SCA group experienced worsening of a visual field deficit or visual acuity attributed to the tumor progression, as did 6 patients (9%) in the NFA group.
Silent corticotroph adenomas exhibited a more aggressive course with a higher progression rate than other subtypes of NFAs. Stereotactic radiosurgery is an important adjuvant treatment for control of tumor growth. Increased radiation dose may lead to improved tumor control in SCA patients.
研究与其他非促肾上腺皮质激素染色无功能垂体腺瘤（NFA）亚型相比，立体定向放射外科（SRS）治疗无功能性垂体腺瘤（NFA）患者中无功能性促皮质素腺瘤（SCA）的安全性和有效性。
对 1994 年 9 月至 2012 年 8 月期间在我们中心接受 SRS 治疗的 104 例 NFA 患者的临床特征和结局进行评估。其中，确认了 34 例连续的 SCA 患者。根据性别、SRS 时的年龄、肿瘤大小、肿瘤边缘放射剂量和随访时间等可比的基线特征，选择了 70 例其他 NFA 亚型的患者作为对照组进行回顾性研究。
SRS 后中位随访时间为 56 个月（范围 6-200 个月）。在随访期间，无 SCA 患者发生库欣病。SCA 组 34 例患者中有 21 例（62%）肿瘤得到控制，NFA 组 70 例患者中有 65 例（93%）肿瘤得到控制。SCA 组的中位无进展生存期（PFS）为 58 个月。SCA 组的 3 年、5 年和 8 年的累积无进展生存率（PFS）分别为 73%、46%和 31%，而 NFA 组的累积无进展生存率（PFS）分别为 94%、87%和 87%。接受剂量≥17 Gy 的 SCA 治疗患者表现出改善的 PFS。SCA 组有 10 例（29%）患者新发垂体功能丧失，而 NFA 组有 18 例（26%）患者新发垂体功能丧失。SCA 组有 8 例（24%）患者因肿瘤进展导致视野缺损或视力恶化，而 NFA 组有 6 例（9%）患者因肿瘤进展导致视野缺损或视力恶化。
无功能性促皮质素腺瘤的进展率高于其他 NFA 亚型，表现出更具侵袭性的病程。立体定向放射外科是控制肿瘤生长的重要辅助治疗方法。增加放射剂量可能会提高 SCA 患者的肿瘤控制率。
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