Yu Jinxiu, Li Yanli, Quan Tingting, Li Xi, Peng Chao, Zeng Jiamin, Liang Shunyao, Huang Minyi, He Yong, Deng Yinhui
Department of Radiotherapy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China.
Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China.
Endocrine. 2020 May;68(2):399-410. doi: 10.1007/s12020-020-02260-1. Epub 2020 Mar 11.
The aim of this study was to evaluate the long-term outcomes of initial Gamma Knife radiosurgery (GKRS) for patients with nonfunctioning pituitary adenomas (NFPAs).
This was a single-center retrospective study. Eighty-one patients with NFPAs undergoing initial GKRS were enrolled. The median age was 44.9 years (range, 7.2-75.5 years). The median tumor volume was 2.3 cm (range, 0.1-31.3 cm), and the median tumor margin dose was 13.0 Gy (range, 8-22 Gy).
Tumor shrunk in 63 patients (77.8%), remained stable in 9 (11.1%), treatment failure in 9 (11.1%) during a median follow-up of 67.1 months (range, 11.5-263.9 months). The tumor control rates were 100%, 99%, 95%, and 84%, at 1, 3, 5, and 10 years, respectively. In multivariate analysis, tumor volume (≥4 cm) and margin dose (<12 Gy) were associated with treatment failure (hazard ratio (HR) = 7.093, 95% confidence interval (CI) = 1.098-45.083, p = 0.040, and HR = 9.643, 95% CI = 1.108-83.927, p = 0.040, respectively). New apoplexy occurred in seven patients (8.6%) after GKRS with a median time of 39.9 months (range, 11.9-166.8 months). In multivariate analysis, tumor volume (≥10 cm) was a significant risk factor (HR = 10.642, 95% CI = 2.121-53.398, p = 0.004). New hypopituitarism occurred in 14 patients (17.3%). No factors were associated with new hypopituitarism. Four patients (4.9%) developed new or worsening visual dysfunction. No new cranial neuropathy was noted.
In this study, initial GKRS can provide a high tumor control rate, as well as a low incidence rate of complications in NFPAs. GKRS may be an alternative initial treatment for selected NFPAs.
本研究旨在评估初次伽玛刀放射外科治疗（GKRS）对无功能垂体腺瘤（NFPAs）患者的长期疗效。
这是一项单中心回顾性研究。纳入81例接受初次GKRS治疗的NFPAs患者。中位年龄为44.9岁（范围7.2 - 75.5岁）。中位肿瘤体积为2.3 cm（范围0.1 - 31.3 cm），中位肿瘤边缘剂量为13.0 Gy（范围8 - 22 Gy）。
在中位随访67.1个月（范围11.5 - 263.9个月）期间，63例患者（77.8%）肿瘤缩小，9例（11.1%）稳定，9例（11.1%）治疗失败。1年、3年、5年和10年的肿瘤控制率分别为100%、99%、95%和84%。多因素分析显示，肿瘤体积（≥4 cm）和边缘剂量（<12 Gy）与治疗失败相关（风险比（HR）分别为7.093，95%置信区间（CI）为1.098 - 45.083，p = 0.040；HR为9.643，95% CI为1.108 - 83.927，p = 0.040）。GKRS后7例患者（8.6%）发生新的卒中，中位时间为39.9个月（范围11.9 - 166.8个月）。多因素分析显示，肿瘤体积（≥10 cm）是一个显著危险因素（HR = 10.642，95% CI为2.121 - 53.398，p = 0.004）。14例患者（17.3%）出现新的垂体功能减退。无因素与新的垂体功能减退相关。4例患者（4.9%）出现新的或加重的视觉功能障碍。未发现新的颅神经病变。
在本研究中，初次GKRS可为NFPAs提供较高的肿瘤控制率以及较低的并发症发生率。GKRS可能是部分NFPAs的一种替代初始治疗方法。
