Department of Neurosurgery, Akita University Graduate School of Medicine.
Department of Stroke Comprehensive Medical Center, Akita University Hospital.
Neurol Med Chir (Tokyo). 2021 Jul 15;61(7):404-413. doi: 10.2176/nmc.oa.2020-0378. Epub 2021 May 14.
The efficacy of stereotactic radiotherapy (SRT) has been well established for postoperative residual and recurrent nonfunctioning pituitary adenomas (NFPAs). However, the risk of visual impairment due to SRT for lesions adjacent to the optic pathways remains a topic of debate. Herein, we evaluated the long-term clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) for perioptic NFPAs. From December 2002 to November 2015, 32 patients (18 males and 14 females; median age 63 years; range, 36-83 years) with residual or recurrent NFPAs abutting or displacing the optic nerve and/or chiasm (ONC) were treated with HFSRT. The median marginal dose was 31.3 Gy (range, 17.2-39.6) in 8 fractions (range, 6-15). Magnetic resonance imaging (MRI) and visual and hormonal examinations were performed before and after HFSRT. The median follow-up period was 99.5 months (range, 9-191). According to MRI findings at the last follow-up, the tumor size had decreased in 28 (88%) of 32 patients, was unchanged in 3 (9%), and had increased in 1 (3%). The successful tumor size control rate was 97%. Visual functions remained unchanged in 19 (60%) out of 32 patients, improved in 11 (34%), and deteriorated in 2 (6%). Two patients had deteriorated visual functions; no complications occurred because of the HFSRT. One patient developed hypopituitarism that required hormone replacement therapy. The result of this long-term follow-up study suggests that HFSRT is safe and effective for the treatment of NFPAs occurring adjacent to the ONC.
立体定向放射治疗（SRT）在术后残留和复发性无功能垂体腺瘤（NFPAs）中的疗效已得到充分证实。然而，由于 SRT 治疗视神经和/或视交叉（ONC）附近病变导致视力损害的风险仍然存在争议。在此，我们评估了适形分割立体定向放射治疗（HFSRT）治疗紧邻视路的 NFPAs 的长期临床结果。从 2002 年 12 月至 2015 年 11 月，32 例（18 名男性和 14 名女性；中位年龄 63 岁；范围 36-83 岁）患有残留或复发性紧邻或推挤视神经和/或视交叉（ONC）的 NFPAs 的患者接受了 HFSRT 治疗。中位边缘剂量为 31.3 Gy（范围 17.2-39.6），共 8 个分次（范围 6-15）。在 HFSRT 前后进行了磁共振成像（MRI）和视觉及激素检查。中位随访时间为 99.5 个月（范围 9-191）。根据最后一次随访时的 MRI 结果，32 例患者中 28 例（88%）肿瘤体积缩小，3 例（9%）肿瘤体积不变，1 例（3%）肿瘤体积增大。肿瘤大小控制的成功率为 97%。32 例患者中 19 例（60%）的视力功能保持不变，11 例（34%）视力改善，2 例（6%）视力恶化。2 例患者视力恶化，没有因 HFSRT 而发生并发症。1 例患者出现垂体功能减退，需要激素替代治疗。这项长期随访研究的结果表明，HFSRT 治疗紧邻 ONC 的 NFPAs 是安全有效的。
