Jordan Justin T, Miller Julie J, Cushing Tucker, Seijo Marlon, Batchelor Tracy T, Arrillaga-Romany Isabel C, Shih Helen A, Nachtigall Lisa B, Loeffler Jay S, Dietrich Jorg
Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital, Boston, MA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Neurooncol Pract. 2018 Mar;5(1):64-68. doi: 10.1093/nop/npx013. Epub 2017 May 26.
Treatment of aggressive pituitary adenomas typically involves a multimodality approach based on histopathological features and may include pharmacotherapy, surgery, and occasionally radiation therapy. In cases of treatment-refractory tumor progression, chemotherapy may be considered; however, no standard chemotherapeutic regimen has been established. Literature review suggests that temozolomide may have a beneficial role in a subset of cases. To understand the efficacy of temozolomide in progressive pituitary tumors, we reviewed the outcomes of cases at our center.
We performed a retrospective chart review to report the outcome and unique features of 7 patients with aggressive functioning pituitary adenomas or carcinomas treated with temozolomide. Tumor pathology included somatotroph (n = 1), corticotroph (n = 3), and lactotroph (n = 3) tumors.
Four of the 7 patients had at least 2 prior resections, and all had prior radiation and surgery before treatment with temozolomide. Notably, all patients showed response to therapy, defined as either stable disease (43%) or partial response (57%). Median progression-free survival was 1.66 years, and median overall survival was 4 years.
Our data suggest that temozolomide has an important role in the management of aggressive functioning pituitary tumors that are resistant to standard therapies, and that optimization of therapy with temozolomide may involve individualized regimens. Future prospective clinical trials should be considered.
侵袭性垂体腺瘤的治疗通常基于组织病理学特征采用多模式方法，可能包括药物治疗、手术，偶尔还包括放射治疗。在治疗难治性肿瘤进展的情况下，可考虑化疗；然而，尚未确立标准的化疗方案。文献综述表明，替莫唑胺可能在一部分病例中发挥有益作用。为了解替莫唑胺在进展性垂体肿瘤中的疗效，我们回顾了我们中心病例的治疗结果。
我们进行了一项回顾性病历审查，以报告7例接受替莫唑胺治疗的侵袭性功能性垂体腺瘤或癌患者的治疗结果和独特特征。肿瘤病理包括生长激素细胞型（n = 1）、促肾上腺皮质激素细胞型（n = 3）和催乳素细胞型（n = 3）肿瘤。
7例患者中有4例至少接受过2次先前的切除术，所有患者在接受替莫唑胺治疗前均接受过放疗和手术。值得注意的是，所有患者均显示出对治疗的反应，定义为疾病稳定（43%）或部分缓解（57%）。无进展生存期的中位数为1.66年，总生存期的中位数为4年。
我们的数据表明，替莫唑胺在对标准治疗耐药的侵袭性功能性垂体肿瘤的管理中具有重要作用，并且替莫唑胺治疗的优化可能涉及个体化方案。应考虑未来进行前瞻性临床试验。
