Benjamin Carolina, Ashayeri Kimberly, Golfinos John G, Placantonakis Dimitris G, Silverman Joshua, Kondziolka Douglas
Department of Neurosurgery, University of Miami, Lois Pope Life Center, 1095 NE 14th Sreet 2nd Floor, Miami, FL, 33136, USA.
Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
Pituitary. 2020 Dec;23(6):665-671. doi: 10.1007/s11102-020-01074-8.
Metastases should be considered in a patient with a cancer history and a sellar/suprasellar lesion, as this diagnosis can change the management strategy in such patients. Once the diagnosis is established, stereotactic radiosurgery (SRS) can be a safe and effective approach for these patients.
This case series describes five patients with pituitary metastases managed with GKRS at a single institution, taken from our prospective registry. All patients had SRS using the Gamma Knife Perfexion or Icon (Elekta), according to our standard institutional protocol. The optic nerves and chiasm were contoured, and the plan was adjusted to restrict dose to the optic apparatus as necessary. The tumor margin doses delivered were 11 Gy, 12 Gy, 14 Gy, 18 Gy (3 sessions of 6 Gy), and 12 Gy at the 50% isodose line.
In this series, all sellar metastases were treated successfully with good radiographic and clinical response. The histology of the tumors included endometrial, gastrointestinal, and lung adenocarcinomas. Typically, histology is taken into consideration when choosing the treatment dose, along with size and location. In these patients, however, the dose used for the sellar metastases was chosen primarily for visual safety. This was typically lower than the dose for brain metastases in other locations.
SRS provides an alternative treatment approach for sellar/suprasellar metastases with excellent local control, symptom improvement and maintenance of systemic therapy as desired. As such, CNS failure is rarely the proximate cause of demise in pituitary metastases provided that endocrinopathies are recognized and managed appropriately.
对于有癌症病史且存在鞍区/鞍上病变的患者，应考虑转移瘤的可能，因为这一诊断可能会改变此类患者的治疗策略。一旦确诊，立体定向放射外科治疗（SRS）对于这些患者可能是一种安全有效的方法。
本病例系列描述了在单一机构接受伽玛刀放射外科治疗（GKRS）的5例垂体转移瘤患者，这些患者来自我们的前瞻性登记系统。根据我们机构的标准方案，所有患者均使用伽玛刀Perfexion或Icon（医科达）进行SRS治疗。对视神经和视交叉进行轮廓勾画，并根据需要调整计划以限制对视器的剂量。在50%等剂量线处给予的肿瘤边缘剂量分别为11 Gy、12 Gy、14 Gy、18 Gy（分3次，每次6 Gy）和12 Gy。
在本系列中，所有鞍区转移瘤均成功接受治疗，影像学和临床反应良好。肿瘤组织学类型包括子宫内膜癌、胃肠道癌和肺腺癌。通常，在选择治疗剂量时会考虑组织学类型以及肿瘤大小和位置。然而，在这些患者中，用于鞍区转移瘤的剂量主要是为了视觉安全而选择的。这通常低于其他部位脑转移瘤的剂量。
SRS为鞍区/鞍上转移瘤提供了一种替代治疗方法，具有出色的局部控制、症状改善以及按需维持全身治疗的效果。因此，只要内分泌疾病得到恰当识别和处理，中枢神经系统衰竭很少是垂体转移瘤患者直接的死亡原因。
