Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Front Endocrinol (Lausanne). 2021 Nov 15;12:725014. doi: 10.3389/fendo.2021.725014. eCollection 2021.
Management of aggressive pituitary adenomas is challenging due to a paucity of rigorous evidence supporting available treatment approaches. Recent guidelines emphasize the need to maximize standard therapies as well as the use of temozolomide and radiation therapy to treat disease recurrence. However, often these adenomas continue to progress over time, necessitating the use of additional targeted therapies which also impact quality of life and long-term outcomes. In this review, we present 9 cases of aggressive pituitary adenomas to illustrate the importance of a multidisciplinary, individualized approach. The timing and rationale for surgery, radiation therapy, temozolomide, somatostatin receptor ligands, and EGFR, VEGF, and mTOR inhibitors in each case are discussed within the context of evidence-based guidelines and clarify strategies for implementing an individualized approach in the management of these difficult-to-treat-adenomas.
由于缺乏严格的证据支持现有治疗方法，侵袭性垂体腺瘤的治疗颇具挑战性。最近的指南强调需要最大限度地利用标准疗法以及替莫唑胺和放射疗法来治疗疾病复发。然而，这些腺瘤往往会随着时间的推移而持续进展，需要使用其他靶向治疗方法，这也会影响生活质量和长期预后。在这篇综述中，我们介绍了 9 例侵袭性垂体腺瘤病例，以说明多学科、个体化治疗方法的重要性。讨论了每个病例中手术、放射治疗、替莫唑胺、生长抑素受体配体以及 EGFR、VEGF 和 mTOR 抑制剂的时机和原理，并结合循证指南阐明了在这些难以治疗的腺瘤的治疗中实施个体化方法的策略。
