Kim Eui Hyun, Oh Min Chul, Chang Jong Hee, Moon Ju Hyung, Ku Cheol Ryong, Chang Won-Seok, Lee Eun Jig, Kim Sun Ho
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Pituitary Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
World Neurosurg. 2018 Feb;110:e534-e545. doi: 10.1016/j.wneu.2017.11.043. Epub 2017 Nov 16.
We aimed to determine the long-term effects of Gamma knife radiosurgery (GKS) on remnants in the cavernous sinus (CS) after transsphenoidal surgery (TSS) for acromegaly and to identify its possible adverse effects.
Thirty patients who had remnant tumors only inside the CS after TSS and who consequently underwent GKS were included. They were followed for a median period of 47 months after GKS with regular hormonal and radiologic examinations.
The mean tumor volume and margin dose irradiated by GKS was 3.7 cm and 26.2 Gy, respectively. Radiologic tumor control was identified in all patients, and no tumor regrowth or recurrent tumors were identified. For 14 patients who achieved endocrinologic remission, the median duration from GKS until remission was 35 months. The actuarial rates of remission at 2, 5, and 10 years were 7.1%, 43.6%, and 65.6%, respectively. The degree of decrease in the nadir GH level in the OGTT at 6 months after GKS was a statistically significant predictor of remission. Newly developed hypopituitarism frequently developed in a time-dependent manner. Radiation necrosis developed in 4 patients with relatively large remnant volumes.
GKS is an effective adjuvant treatment option for remnant tumors inside the CS after TSS. Maximal surgical resection, leaving minimal volume of remnants only inside the CS, allows the safe and sufficient delivery of a radiation dose to tumors, thereby increasing the possibility of remission. However, the risk of new hypopituitarism and radiation necrosis should be considered when tumors inside the CS are treated with GKS.
我们旨在确定伽玛刀放射外科治疗（GKS）对肢端肥大症经蝶窦手术（TSS）后海绵窦（CS）内残留肿瘤的长期影响，并确定其可能的不良反应。
纳入30例TSS后仅CS内有残留肿瘤并因此接受GKS治疗的患者。GKS后对他们进行了为期47个月的随访，定期进行激素和影像学检查。
GKS照射的平均肿瘤体积和边缘剂量分别为3.7 cm和26.2 Gy。所有患者均实现影像学肿瘤控制，未发现肿瘤复发或再发肿瘤。对于14例实现内分泌缓解的患者，从GKS到缓解的中位持续时间为35个月。2年、5年和10年的缓解精算率分别为7.1%、43.6%和65.6%。GKS后6个月口服葡萄糖耐量试验（OGTT）中最低生长激素（GH）水平的下降程度是缓解的统计学显著预测指标。新发生的垂体功能减退症经常呈时间依赖性发展。4例残留体积相对较大的患者发生了放射性坏死。
GKS是TSS后CS内残留肿瘤的有效辅助治疗选择。最大程度的手术切除，仅在CS内留下最小体积的残留，可安全、充分地向肿瘤输送放射剂量，从而增加缓解的可能性。然而，用GKS治疗CS内肿瘤时应考虑新发生垂体功能减退症和放射性坏死的风险。
