Department of Neurosurgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, 40705, Taichung, Taiwan.
Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
J Neurooncol. 2018 Sep;139(3):767-775. doi: 10.1007/s11060-018-2925-2. Epub 2018 Jun 13.
Gamma knife treatment outcome of large pituitary tumors which are only partially irradiated secondary to immediate proximity to critical structures such as the optic apparatus have not been rigorously studied.
From July 2003 to December 2013, there were 41 cases of recurrent or residual nonfunctioning pituitary macroadenoma partially treated with gamma knife radiosurgery (GKRS) because the adenoma obscured part of the optic apparatus on planning SRS MR imaging.
The follow up period after GKRS was 92.3 ± 5.6 months. The percentage of tumor coverage with the full dose was 88.5 ± 0.7%. Five of 43 (11.6%) patients experienced a transient visional decrease and one patient experienced a permanent visual field defect. During the follow up, two patients underwent transphenoidal surgery and one patient had a craniotomy due to tumor progression. Seven patients (16.2%) developed cortisol and thyroxine deficiencies. In multiple variant analyses, transient visual decline was correlated to the tumor volume (> 3.5 cc), percentage of tumor coverage (< 90%), the distance from the optic apparatus to the pituitary stalk (> 15 mm) and percentage of tumor above the orbital apex (65%).
In the limited case of this cohort, we found that partially treated pituitary nonfunctioning macroadenoma yielded a high tumor control rate. However, visual decline as a result of tumor progression or radiation effect can occur in a minority of patients. The radiosurgical technique warrants further study to better define the long-term risk to benefit profile for its use in complex pituitary macroadenoma obscuring part of the optic apparatus.
由于紧邻重要结构（如视器），部分照射的大型垂体瘤伽玛刀治疗结果（gamma knife treatment outcome），即大腺瘤在伽玛刀放射外科治疗（gamma knife radiosurgery，GKRS）后复发或残留，尚未得到严格研究。
从 2003 年 7 月至 2013 年 12 月，由于计划 SRS MRI 上视器部分被肿瘤遮挡，41 例复发性或残留无功能垂体大腺瘤部分接受了伽玛刀放射外科治疗（GKRS）。
GKRS 后随访时间为 92.3±5.6 个月。肿瘤的全剂量覆盖率为 88.5±0.7%。43 例中有 5 例（11.6%）患者出现一过性视力下降，1 例患者出现永久性视野缺损。随访期间，2 例患者接受了经蝶窦手术，1 例患者因肿瘤进展而行开颅手术。7 例（16.2%）患者出现皮质醇和甲状腺素缺乏。在多变量分析中，一过性视力下降与肿瘤体积（>3.5cc）、肿瘤覆盖率（<90%）、视器至垂体柄的距离（>15mm）和肿瘤超过眶尖的百分比（65%）相关。
在本队列的有限病例中，我们发现部分治疗的无功能垂体大腺瘤肿瘤控制率较高。然而，由于肿瘤进展或放射效应，少数患者可能出现视力下降。放射外科技术需要进一步研究，以更好地确定其在部分遮挡视器的复杂垂体大腺瘤中的长期风险获益比。
