Minniti Giuseppe, Paolini Sergio, Rea Marie Lise Jaffrain, Isidori Andrea, Scaringi Claudia, Russo Ivana, Osti Mattia Falchetto, Cavallo Luigi, Esposito Vincenzo
Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100, Siena, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
J Neurooncol. 2020 Aug;149(1):123-130. doi: 10.1007/s11060-020-03579-5. Epub 2020 Jul 6.
To evaluate the efficacy of a second course of fractionated stereotactic radiotherapy (re-SRT) and temozolomide (TMZ) as salvage treatment option in patients with aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs).
Twenty-one patients with recurrent or progressive APTs (n = 17) and PCs (n = 4) who received combined TMZ and re-SRT, 36 Gy/18fractions or 37.5 Gy/15fractions, were retrospectively evaluated. TMZ was given at a dose of 75 mg/m given concurrently to re-SRT, and then 150-200 mg/m/day for 5 days every 4 weeks or 50 mg/m daily for 12 months. Local control (LC) and overall survival (OS) were calculated from the time of re-SRT by Kaplan-Meier method.
With a median follow-up of 27 months (range 12-58 months), 2-year and 4-year LC rates were 73% and 65%, respectively; 2-year and 4-year survival rates were 82% and 66%, respectively. A complete response was achieved in 2 and partial response in 11 patients. Six patients recurred with a median time to progression of 14 months. O(6)-Methylguanine-DNA methyltransferase (MGMT) status and tumor volume emerged as prognostic factors. Grade 3 radiation-related toxicities occurred in 3 (14%) patients. Grade 2 or 3 hematologic toxicities during chemotherapy occurred in 8 (38%) patients.
Re-SRT and TMZ is a safe treatment offering high LC in patients with progressive APTs and PCs. The potential advantages of combined chemoradiation as up-front or salvage treatment need to be explored in prospective trials.
评估分割立体定向放射治疗（再程立体定向放射治疗，re-SRT）联合替莫唑胺（TMZ）作为侵袭性垂体瘤（APTs）和垂体癌（PCs）挽救治疗方案的疗效。
回顾性评估21例接受TMZ联合re-SRT治疗的复发性或进展性APTs患者（n = 17）和PCs患者（n = 4），re-SRT剂量为36 Gy/18次分割或37.5 Gy/15次分割。TMZ剂量为75 mg/m²，在re-SRT期间同步给药，然后每4周150 - 200 mg/m²/天，连用5天，或50 mg/m²/天，连用12个月。采用Kaplan-Meier法从再程立体定向放射治疗时间开始计算局部控制率（LC）和总生存率（OS）。
中位随访27个月（范围12 - 58个月），2年和4年LC率分别为73%和65%；2年和4年生存率分别为82%和66%。2例患者达到完全缓解，11例患者部分缓解。6例患者复发，中位进展时间为14个月。O(6)-甲基鸟嘌呤-DNA甲基转移酶（MGMT）状态和肿瘤体积是预后因素。3例（14%）患者发生3级放射性毒性反应。化疗期间8例（38%）患者发生2级或3级血液学毒性反应。
再程立体定向放射治疗联合替莫唑胺是一种安全的治疗方法，可为进展性APTs和PCs患者提供较高的局部控制率。联合放化疗作为初始或挽救治疗的潜在优势需要在前瞻性试验中进行探索。
