Sun Shibin, Liu Ali, Zhang YaZhuo
Capital Medical University, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Gamma Knife Center, Beijing, China.
Capital Medical University, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Beijing Institute for Brain Disorders Brain Tumor Center, China National Clinical Research Center for Neurological Diseases, Key Laboratory of Central Nervous System Injury Research, Beijing, China.
World Neurosurg. 2019 Apr;124:e715-e723. doi: 10.1016/j.wneu.2019.01.009. Epub 2019 Jan 17.
The aim of this study was to evaluate the long-term clinical outcomes of Gamma Knife radiosurgery (GKRS) for residual and recurrent nonfunctioning pituitary adenomas (NFPAs) after surgery and the role of GKRS in the management of NFPAs.
Between January 2000 and December 2010, 204 patients with residual or recurrent NFPAs undergoing GKRS were enrolled in this study according to the inclusion criteria. The median age of the patients was 48 years (mean, 48 years; range, 14-79 years). The median tumor volume was 3.3 mL (mean, 5.2 mL; range, 0.3-26.4 mL). The median margin dose was 14 Gy (mean, 14 Gy; range, 9-18 Gy). The median maximum dose was 31 Gy (mean, 30 Gy; 20-40 Gy). The median duration of follow-up was 86 months (mean, 88 months; range, 12-213 months).
Of these 204 patients, the latest follow-up magnetic resonance imaging studies showed tumor regression in 102 patients (50%), tumor stability in 81 patients (40%), and tumor enlargement in 21 patients (10%). The tumor control rate of this cohort was 90%. The cumulative progression-free survival at 3, 5, 8, 10, and 15 years was 97%, 95%, 92%, 92%, and 81%, respectively. Thirty-seven patients (18%) developed new-onset hypopituitarism, with 1 patient experiencing panhypopituitarism. Five patients (2.5%) presented with new or worsening visual dysfunction without tumor growth. No new cranial nerve dysfunction was shown and no second brain tumor was identified.
GKRS provided high tumor control and a low complication rate in our long-term follow-up. We recommend that early GKRS should be considered the routine adjuvant treatment for residual NFPAs approximately 6 months after subtotal surgical resection.
本研究旨在评估伽玛刀放射外科手术（GKRS）治疗手术后残留及复发性无功能垂体腺瘤（NFPAs）的长期临床疗效，以及GKRS在NFPAs治疗中的作用。
2000年1月至2010年12月期间，根据纳入标准，204例残留或复发性NFPAs患者接受了GKRS治疗并纳入本研究。患者的中位年龄为48岁（平均48岁；范围14 - 79岁）。中位肿瘤体积为3.3 mL（平均5.2 mL；范围0.3 - 26.4 mL）。中位边缘剂量为14 Gy（平均14 Gy；范围9 - 18 Gy）。中位最大剂量为31 Gy（平均30 Gy；20 - 40 Gy）。中位随访时间为86个月（平均88个月；范围12 - 213个月）。
在这204例患者中，最新的随访磁共振成像研究显示，102例患者（50%）肿瘤缩小，81例患者（40%）肿瘤稳定，21例患者（10%）肿瘤增大。该队列的肿瘤控制率为90%。3年、5年、8年、10年和15年的累积无进展生存率分别为97%、95%、92%、92%和81%。37例患者（18%）出现新发垂体功能减退，其中1例患者出现全垂体功能减退。5例患者（2.5%）出现新的或加重的视觉功能障碍，但无肿瘤生长。未显示新的颅神经功能障碍，也未发现第二原发性脑肿瘤。
在我们的长期随访中，GKRS提供了高肿瘤控制率和低并发症发生率。我们建议，对于次全手术切除后约6个月的残留NFPAs，应考虑早期GKRS作为常规辅助治疗。
