Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2022 Dec;63(12):1059-1068. doi: 10.3349/ymj.2022.0323.
This study aimed to evaluate the efficacy of radiation therapy (RT) for recurrent or residual pituitary macroadenoma (PMA) invading extrasellar regions.
Patients from 2000 to 2020 who received RT with conventional fractionation for recurrent or residual PMA were included. The patients were divided according to the type of tumor [functioning (fx) or non-fx] and the aim of RT (salvage RT alone, immediate postoperative RT, delayed postoperative RT). Local and biochemical failure-free rates (FFR) were calculated using the Kaplan-Meier method.
With a median follow up of 82 months (IQR; 42-132 months), 36 patients treated with conventional RT (total 45-54 Gy in 1.8 or 2 Gy per fraction) for recurrent or residual PMA were analyzed. The 10-year local FFRs after RT for non-fx and fx tumor were 100% and 74.4%, respectively (=0.047). In the immediate postoperative RT group, the 10-year local FFR was 100%, which was higher than the 90% FFR for salvage RT alone or 80% FFR for the delayed postoperative RT group (overall =0.043, immediate vs. salvage; =0.312, immediate vs. delayed; =0.072). The local FFR was compared according to size of tumor with a cut-off value of 4 cm, and there was no significant difference (10-year local FFR 100% vs. 84.7% for >4 cm vs. <4 cm, =0.320). The extents of extrasellar region invasion were not predictive of local failure after RT. We found no grade ≥3 acute toxicities or newly developed visual impairments as a late toxicity of RT.
Conventional RT is safe and effective for the local control of recurrent or residual PMA. Our data suggest that immediate postoperative RT can be beneficial in recurrent or residual PMA, although further studies to evaluate risk factors of treatment failure in terms of treatment and disease characteristics are required.
本研究旨在评估放射治疗（RT）治疗侵袭鞍旁区的复发性或残留垂体大腺瘤（PMA）的疗效。
纳入 2000 年至 2020 年期间接受常规分割 RT 治疗复发性或残留 PMA 的患者。根据肿瘤类型[功能性（fx）或非功能性（nfx）]和 RT 目的（单纯挽救性 RT、即刻术后 RT、延迟术后 RT）将患者进行分组。采用 Kaplan-Meier 法计算局部和生化无失败率（FFR）。
中位随访 82 个月（IQR：42-132 个月），对 36 例接受常规 RT（总剂量 45-54 Gy，1.8 或 2 Gy/次）治疗复发性或残留 PMA 的患者进行了分析。RT 治疗 nfx 和 fx 肿瘤后 10 年局部 FFR 分别为 100%和 74.4%（=0.047）。即刻术后 RT 组 10 年局部 FFR 为 100%，高于单纯挽救性 RT 的 90% FFR 或延迟术后 RT 的 80% FFR（总体=0.043，即刻 vs. 挽救；=0.312，即刻 vs. 延迟；=0.072）。根据肿瘤大小（以 4cm 为界）进行局部 FFR 比较，差异无统计学意义（10 年局部 FFR：4cm 以上为 100%，4cm 以下为 84.7%，=0.320）。鞍旁区侵袭范围与 RT 后局部失败无关。我们未发现 3 级及以上急性毒性反应，也未发现 RT 后新出现的视力障碍等迟发性毒性反应。
常规 RT 是安全有效的，可用于控制复发性或残留 PMA 的局部进展。我们的数据表明，即刻术后 RT 对复发性或残留 PMA 有益，尽管需要进一步研究以评估治疗和疾病特征方面的治疗失败风险因素。
