Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA.
Biostatistics Shared Resource, Winship Cancer Institute at Emory University, Atlanta, Georgia, USA.
World Neurosurg. 2022 Apr;160:e33-e39. doi: 10.1016/j.wneu.2021.12.087. Epub 2021 Dec 28.
Adjuvant radiotherapy (RT) can help achieve local control (LC) and reduce hormonal overexpression for pituitary adenomas (PAs). Prior reports involved Gamma Knife or older linear accelerator (LINAC) techniques. The aim of this study was to report long-term outcomes for modern LINAC RT.
Institutional retrospective review of LINAC RT for PAs with minimum 3 years of magnetic resonance imaging follow-up was performed. Hormonal control was defined as biochemical remission in absence of medications targeting hormone excess. LC defined using Response Evaluation Criteria in Solid Tumors on surveillance magnetic resonance imaging. Progression-free survival defined as time alive with LC without return of or worsening hormonal excess from secretory PA. Kaplan-Meier and Cox proportional hazard models used.
From 2003 to 2017, 140 patients with PAs (94 nonsecretory, 46 secretory) were treated with LINAC RT (105 fractionated RT, 35 radiosurgery) with median follow-up of 5.35 years. Techniques included fixed gantry intensity-modulated radiotherapy (51.4%), dynamic conformal arcs (9.3%), and volumetric modulated arc therapy (39.3%). Progression-free survival at 5 years was 95.3% for secretory tumors and 94.8% for nonsecretory tumors. Worse progression-free survival was associated with larger planning target volume on multivariable analysis (hazard ratio 2.87, 95% confidence interval 1.01-8.21, P = 0.049). Hormonal control at 5 years was 50.0% and associated with higher dose to tumor (hazard ratio 1.05, 95% confidence interval 1.02-1.09, P = 0.005) and number of surgeries (hazard ratio 1.74, 95% confidence interval 1.05-2.89, P = 0.032). Patients requiring any pituitary hormone replacement increased from 57.9% to 70.0% after RT.
Modern LINAC RT for patients with PAs was safe and effective for hormonal control and LC. No difference in LC was noted for functional versus nonfunctional tumors, possibly owing to higher total dose and daily image guidance.
辅助放疗（RT）有助于实现垂体腺瘤（PA）的局部控制（LC）并减少激素过表达。先前的报告涉及伽玛刀或较旧的直线加速器（LINAC）技术。本研究旨在报告现代 LINAC RT 的长期结果。
对至少有 3 年磁共振成像随访的 PA 患者进行 LINAC RT 的机构回顾性研究。激素控制定义为无针对激素过多的药物治疗时的生化缓解。LC 使用实体瘤反应评估标准在监测磁共振成像上定义。无进展生存期定义为在无 LC 且无分泌性 PA 激素过度复发或恶化的情况下生存时间。使用 Kaplan-Meier 和 Cox 比例风险模型。
2003 年至 2017 年，对 140 例 PA 患者（94 例非分泌性，46 例分泌性）采用 LINAC RT（105 分次 RT，35 例放射外科手术）进行治疗，中位随访时间为 5.35 年。技术包括固定龙门强度调制放疗（51.4%）、动态适形弧（9.3%）和容积调强弧形治疗（39.3%）。5 年无进展生存率为分泌性肿瘤 95.3%，非分泌性肿瘤 94.8%。多变量分析显示较大的计划靶区体积与无进展生存率较差相关（风险比 2.87，95%置信区间 1.01-8.21，P=0.049）。5 年时的激素控制率为 50.0%，与肿瘤更高剂量（风险比 1.05，95%置信区间 1.02-1.09，P=0.005）和手术次数（风险比 1.74，95%置信区间 1.05-2.89，P=0.032）相关。RT 后，需要任何垂体激素替代的患者比例从 57.9%增加到 70.0%。
现代 LINAC RT 治疗 PA 患者安全有效，可实现激素控制和 LC。功能性肿瘤与非功能性肿瘤的 LC 无差异，这可能是由于更高的总剂量和每日图像引导。
