Katsuta Hospital Mito GammaHouse, Hitachi-naka, Ibaraki, Japan.
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Neurosurgery. 2019 Oct 1;85(4):476-485. doi: 10.1093/neuros/nyy357.
There is little information on long-term outcomes after salvage treatment by either surgery or stereotactic radiosurgery (SRS) for patients with recurrent/residual nonfunctioning pituitary adenomas (NFPAs).
To reappraise the efficacy and safety of SRS for patients with NFPAs touching/compressing the optic apparatus (OA).
We studied 27 patients (14 females, 13 males; mean age: 61 [range, 19-85] yr) who underwent SRS between 1998 and 2008 for NFPAs with such condition. The median tumor volume was 4.9 (range, 1.8-50.8) cc. To avoid excess irradiation to the OA, the lower part of the tumor was covered with a 50% or a 60% isodose gradient, ie 49% to 98% (mean, 84%; median, 88%) of the entire tumor received the selected doses. Median doses at the tumor periphery/OA were 7.6/11.0 (interquartile range [IQR], 5.8-9.1/10.1-11.8) Gy.
Seven patients (26%) were confirmed to be deceased due to unrelated diseases at a median post-SRS period of 149 (IQR, 83-158) mo. Follow-up magnetic resonance imaging (MRI) showed tumor growth in 2 patients (7%) at the 11th and 134th post-SRS month; the former underwent surgery and the other SRS. Excluding these 2 patients, the latest follow-up MRI examinations, performed 13 to 238 (median: 168, IQR: 120-180) mo after SRS, showed no size changes in 5 (19%) and shrinkage in 20 (74%) patients. Cumulative incidences of tumor growth control were 96.3% and 91.8% at the 120th and 180th post-SRS month. None of our patients developed subjective symptoms suggesting SRS-induced optic neuropathy or endocrinological impairment.
In patients with NFPAs touching/compressing the OA, SRS achieves good long-term results.
对于复发/残留无功能垂体腺瘤（NFPAs）患者，手术或立体定向放射外科（SRS）挽救治疗后的长期结果信息较少。
重新评估 SRS 治疗压迫/接触视器（OA）的 NFPAs 患者的疗效和安全性。
我们研究了 27 例（14 名女性，13 名男性；平均年龄：61 岁[范围：19-85 岁]）1998 年至 2008 年间因 NFPAs 压迫/接触 OA 而行 SRS 的患者。肿瘤体积中位数为 4.9cc（范围：1.8-50.8cc）。为避免对 OA 的过度照射，肿瘤的下部用 50%或 60%的等剂量梯度覆盖，即整个肿瘤的 49%至 98%（平均 84%；中位数 88%）接受了选定的剂量。肿瘤边缘/OA 的中位剂量分别为 7.6Gy/11.0Gy（四分位距[IQR]，5.8-9.1Gy/10.1-11.8Gy）。
7 例（26%）患者因无关疾病在 SRS 后 149 个月（IQR：83-158 个月）时被确认死亡。SRS 后的随访磁共振成像（MRI）显示，2 例（7%）患者分别在第 11 个月和第 134 个月时肿瘤生长；前者行手术治疗，后者行 SRS 治疗。排除这 2 例患者，在 SRS 后 13 至 238 个月（中位数：168 个月，IQR：120-180 个月）进行的最新随访 MRI 检查中，5 例（19%）肿瘤无变化，20 例（74%）肿瘤缩小。SRS 后 120 个月和 180 个月肿瘤生长控制的累积发生率分别为 96.3%和 91.8%。我们的患者均未出现提示 SRS 诱导的视神经病变或内分泌损害的主观症状。
对于压迫/接触 OA 的 NFPAs 患者，SRS 可获得良好的长期效果。
