Servicio de Neurocirugía, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain.
Servicio de Endocrinología Y Nutrición, Hospital Universitario de Burgos, Burgos, Spain.
Clin Transl Oncol. 2018 Oct;20(10):1233-1245. doi: 10.1007/s12094-018-1868-6. Epub 2018 Apr 5.
At least 50% of surgically resected non-functioning pituitary adenomas (NFPA) recur. Either early or late adjuvant radiotherapy is highly efficacious in controlling recurrent NFPA but associates potentially burdensome complications like hypopituitarism, vascular complications or secondary neoplasm. Reoperation is indicated in bulky tumor rests compressing the optic pathway. To date, no standardized medical therapy is available for recurrent NFPA although cabergoline and temozolomide show promising results. Guidelines on the management of recurrent NFPAs are now available. The new 2017 WHO pituitary tumor classification, based on immunohistochemistry and transcription factor assessment, identifies a group of aggressive NFPA variants that may benefit from earlier adjuvant therapy. Nevertheless, NFPA patients exhibit a reduced overall life expectancy largely due to hypopituitarism and treatment-related morbidity. The management of recurrent NFPA benefits from a multidisciplinary teamwork of surgeons, endocrinologists, radiation oncologists, ophthalmologists, pathologists and neuro-radiologists in order to provide individualized therapy and anticipate deterioration.
至少有 50%的手术切除的无功能垂体腺瘤（NFPA）会复发。早期或晚期辅助放疗在控制复发性 NFPA 方面非常有效，但也会引起潜在的负担性并发症，如垂体功能减退、血管并发症或继发性肿瘤。对于压迫视神经通路的大块肿瘤残余，需要再次手术。迄今为止，虽然卡麦角林和替莫唑胺显示出有希望的结果，但对于复发性 NFPA 尚无标准化的药物治疗。目前已经有关于复发性 NFPAs 的管理指南。基于免疫组化和转录因子评估的新的 2017 年 WHO 垂体肿瘤分类，确定了一组侵袭性 NFPA 变体，它们可能受益于更早的辅助治疗。然而，NFPA 患者的总体预期寿命缩短，主要是由于垂体功能减退和治疗相关的发病率。为了提供个体化治疗和预测病情恶化，复发性 NFPA 的管理受益于外科医生、内分泌学家、放射肿瘤学家、眼科医生、病理学家和神经放射学家的多学科团队协作。
