Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Int J Radiat Oncol Biol Phys. 2018 Jul 1;101(3):618-623. doi: 10.1016/j.ijrobp.2018.02.169. Epub 2018 Mar 8.
To analyze factors associated with post-stereotactic radiosurgery (SRS) hypopituitarism among radiation-naïve patients with pituitary adenomas who underwent single-fraction SRS between 2007 and 2014.
This was a retrospective review of 97 patients having single-fraction SRS from 2007 until 2014. Eligible patients had no history of prior radiation, normal age- and sex-specific pituitary function before SRS, and at least 24 months of endocrine follow-up. Forty patients (41%) had hormone-secreting tumors; 57 patients had nonsecreting tumors (59%). The median prescription isodose volume was 2.8 cm (interquartile range [IQR], 1.3-4.7); the median tumor margin dose was 20 Gy (IQR, 15-25 Gy).
The median follow-up after SRS was 48 months (IQR, 34-68 months). Twenty-seven patients (28%) developed pituitary insufficiency at a median of 22 months (IQR, 12-36 months) after SRS. The rate of new endocrine deficits was 17% at 2 years (95% confidence interval [CI] 10%-25%) and 31% at 5 years (95% CI 20%-42%). Male sex (hazard ratio [HR] 2.38, 95% CI 1.05-5.26, P = .04), smaller pituitary gland volume (HR 0.99, 95% CI 0.99-0.99, P = .01), and higher mean pituitary gland dose (HR 1.31, 95% CI 1.16-1.47, P < .001) were associated with post-SRS hypopituitarism in multivariable analysis. The rate of hypopituitarism for patients with a mean gland dose of <11.0 Gy at 2 years was 2% (95% CI 0%-4%) and at 5 years was 5% (95% CI 0%-11%), whereas rate of hypopituitarism for patients with a mean gland dose of ≥11.0 Gy at 2 years was 31% (95% CI 17%-43%) and at 5 years was 51% (95% CI 34%-65%).
Hypopituitarism after pituitary adenoma SRS increases in a time- and dose-dependent manner. Reducing the radiation exposure to the identifiable gland to a mean dose < 11.0 Gy whenever feasible may lower the incidence of new hormonal deficits after pituitary adenoma SRS.
分析 2007 年至 2014 年间接受单次分割立体定向放射外科（SRS）治疗的垂体腺瘤初治患者中与 SRS 后垂体功能减退相关的因素。
这是一项对 2007 年至 2014 年间接受单次分割 SRS 的 97 例患者进行的回顾性研究。符合条件的患者在 SRS 前无放射治疗史，年龄和性别特异的垂体功能正常，并且至少有 24 个月的内分泌随访。40 例（41%）患者为激素分泌性肿瘤；57 例患者为无分泌性肿瘤（59%）。中位处方等剂量体积为 2.8cm（四分位间距 [IQR]，1.3-4.7）；中位肿瘤边缘剂量为 20Gy（IQR，15-25Gy）。
SRS 后中位随访时间为 48 个月（IQR，34-68 个月）。27 例（28%）患者在 SRS 后中位 22 个月（IQR，12-36 个月）时出现垂体功能减退。2 年时新发内分泌缺陷的发生率为 17%（95%置信区间 [CI]，10%-25%），5 年时为 31%（95% CI，20%-42%）。男性（危险比 [HR] 2.38，95%CI 1.05-5.26，P=0.04）、较小的垂体体积（HR 0.99，95%CI 0.99-0.99，P=0.01）和较高的平均垂体剂量（HR 1.31，95%CI 1.16-1.47，P<.001）与多变量分析中的 SRS 后垂体功能减退相关。2 年时平均腺体剂量<11.0Gy 的患者的垂体功能减退发生率为 2%（95%CI，0%-4%），5 年时为 5%（95%CI，0%-11%）；而平均腺体剂量≥11.0Gy 的患者 2 年时的垂体功能减退发生率为 31%（95%CI，17%-43%），5 年时为 51%（95%CI，34%-65%）。
垂体腺瘤 SRS 后垂体功能减退的发生率呈时间和剂量依赖性增加。只要可行，将可识别腺体的放射暴露降低至平均剂量<11.0Gy，可能会降低垂体腺瘤 SRS 后新发激素缺乏的发生率。
