Hung Yi-Chieh, Lee Cheng-Chia, Yang Huai-Che, Mohammed Nasser, Kearns Kathryn N, Nabeel Ahmed M, Abdel Karim Khaled, Emad Eldin Reem M, El-Shehaby Amr M N, Reda Wael A, Tawadros Sameh R, Liscak Roman, Jezkova Jana, Lunsford L Dade, Kano Hideyuki, Sisterson Nathaniel D, Martínez Álvarez Roberto, Martínez Moreno Nuria E, Kondziolka Douglas, Golfinos John G, Grills Inga, Thompson Andrew, Borghei-Razavi Hamid, Maiti Tanmoy Kumar, Barnett Gene H, McInerney James, Zacharia Brad E, Xu Zhiyuan, Sheehan Jason P
1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
2Departments of Neurosurgery and Surgery, Chi-Mei Medical Center, Tainan.
J Neurosurg. 2019 Aug 2;133(3):717-726. doi: 10.3171/2019.4.JNS183443. Print 2020 Sep 1.
The most common functioning pituitary adenoma is prolactinoma. Patients with medically refractory or residual/recurrent tumors that are not amenable to resection can be treated with stereotactic radiosurgery (SRS). The aim of this multicenter study was to evaluate the role of SRS for treating prolactinomas.
This retrospective study included prolactinomas treated with SRS between 1997 and 2016 at ten institutions. Patients' clinical and treatment parameters were investigated. Patients were considered to be in endocrine remission when they had a normal level of prolactin (PRL) without requiring dopamine agonist medications. Endocrine control was defined as endocrine remission or a controlled PRL level ≤ 30 ng/ml with dopamine agonist therapy. Other outcomes were evaluated including new-onset hormone deficiency, tumor recurrence, and new neurological complications.
The study cohort comprised 289 patients. The endocrine remission rates were 28%, 41%, and 54% at 3, 5, and 8 years after SRS, respectively. Following SRS, 25% of patients (72/289) had new hormone deficiency. Sixty-three percent of the patients (127/201) with available data attained endocrine control. Three percent of patients (9/269) had a new visual complication after SRS. Five percent of the patients (13/285) were recorded as having tumor progression. A pretreatment PRL level ≤ 270 ng/ml was a predictor of endocrine remission (p = 0.005, adjusted HR 0.487). An increasing margin dose resulted in better endocrine control after SRS (p = 0.033, adjusted OR 1.087).
In patients with medically refractory prolactinomas or a residual/recurrent prolactinoma, SRS affords remarkable therapeutic effects in endocrine remission, endocrine control, and tumor control. New-onset hypopituitarism is the most common adverse event.
最常见的功能性垂体腺瘤是泌乳素瘤。对于药物治疗无效或残留/复发且不宜切除的肿瘤患者，可采用立体定向放射外科治疗（SRS）。本多中心研究的目的是评估SRS治疗泌乳素瘤的作用。
这项回顾性研究纳入了1997年至2016年间在10家机构接受SRS治疗的泌乳素瘤患者。对患者的临床和治疗参数进行了调查。当患者泌乳素（PRL）水平正常且无需多巴胺激动剂药物时，被认为处于内分泌缓解状态。内分泌控制定义为内分泌缓解或通过多巴胺激动剂治疗使PRL水平控制在≤30 ng/ml。还评估了其他结局，包括新发激素缺乏、肿瘤复发和新的神经并发症。
研究队列包括289例患者。SRS后3年、5年和8年的内分泌缓解率分别为28%、41%和54%。SRS后，25%的患者（72/289）出现新发激素缺乏。有可用数据的患者中，63%（127/201）实现了内分泌控制。3%的患者（9/269）在SRS后出现新的视力并发症。5%的患者（13/285）被记录为有肿瘤进展。治疗前PRL水平≤270 ng/ml是内分泌缓解的预测因素（p = 0.005，调整后HR 0.487）。边缘剂量增加导致SRS后内分泌控制更好（p = 0.033，调整后OR 1.087）。
对于药物治疗无效的泌乳素瘤或残留/复发性泌乳素瘤患者，SRS在内分泌缓解、内分泌控制和肿瘤控制方面具有显著的治疗效果。新发垂体功能减退是最常见的不良事件。
