Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA.
Neurosurgery. 2023 May 1;92(5):1035-1042. doi: 10.1227/neu.0000000000002347. Epub 2023 Jan 17.
Delayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas.
To investigate the relationship between neuroanatomic structure distances from the radiation target and anterior pituitary function preservation after SRS through multicenter study.
We retrospectively reviewed the International Radiosurgery Research Foundation database from January 2002 to December 2021 for adult patients undergoing SRS for pituitary adenomas with >6 months of follow-up. Distances between centers or edges of hypothalamic-pituitary axis structures and SRS target volumes were measured using MRI. The primary outcome was anterior pituitary function preservation. Predictors were analyzed using multivariable logistic regression and area under the receiver operating curve (AUROC) curve analyses.
Four hundred eighty-seven patients were categorized by preservation (n = 384) and no preservation (n = 103) of anterior pituitary function. The mean margin dose was 19.1(6.2) Gy. Larger distance from the center of the stalk to the tumor margin isodose was a positive predictor (adjusted odds ratio [aOR] = 1.162 [1.046-1.291], P = .005), while pre-SRS hypopituitarism (aOR = 0.646 [0.405-1.031], P = .067) and larger treatment volume (aOR = 0.965 [0.929-1.002], P = .061) were near negative predictors of the primary outcome. An interaction between the treatment volume and center stalk to margin isodose distance was found (aOR = 0.980 [0.961-0.999], P = .045). Center stalk to margin isodose distance had an AUROC of 0.620 (0.557-0.693), at 3.95-mm distance. For patients with treatment volumes of <2.34 mL, center stalk to margin isodose distance had an AUROC of 0.719 (0.614-0.823), at 2.95-mm distance.
Achieving a distance between the center of the pituitary stalk and the tumor margin isodose ≥3.95 mm predicted anterior pituitary function preservation. For smaller treatment volumes <2.34 mL, the optimal distance was ≥2.95 mm. This may be modifiable during trans-sphenoidal resection to preserve pituitary function.
立体定向放射外科（SRS）治疗垂体腺瘤后，迟发性垂体功能减退是最常见的并发症。
通过多中心研究探讨神经解剖结构与 SRS 后垂体前叶功能保存之间的关系。
我们回顾性分析了 2002 年 1 月至 2021 年 12 月期间国际放射外科研究基金会数据库中接受 SRS 治疗、随访时间>6 个月的成人垂体腺瘤患者的资料。使用 MRI 测量下丘脑-垂体轴结构中心或边缘与 SRS 靶区之间的距离。主要结局为垂体前叶功能保存。采用多变量逻辑回归和受试者工作特征曲线（ROC）曲线分析预测因子。
487 例患者根据垂体前叶功能的保存情况（n=384）和不保存情况（n=103）进行分类。平均边缘剂量为 19.1（6.2）Gy。肿瘤边缘等剂量线与垂体柄中心之间的距离越大，是正预测因子（校正优势比[aOR]=1.162[1.046-1.291]，P=0.005），而 SRS 前垂体功能减退（aOR=0.646[0.405-1.031]，P=0.067）和较大的治疗体积（aOR=0.965[0.929-1.002]，P=0.061）则接近负预测因子。还发现治疗体积和垂体柄中心到边缘等剂量线之间存在交互作用（aOR=0.980[0.961-0.999]，P=0.045）。垂体柄中心到边缘等剂量线的曲线下面积（AUROC）为 0.620（0.557-0.693），距离为 3.95mm。对于治疗体积<2.34ml 的患者，垂体柄中心到边缘等剂量线的 AUROC 为 0.719（0.614-0.823），距离为 2.95mm。
达到垂体柄中心与肿瘤边缘等剂量线之间的距离≥3.95mm 可预测垂体前叶功能的保存。对于治疗体积<2.34ml 的患者，最佳距离≥2.95mm。这在经蝶窦切除术中可能是可以改变的，以保留垂体功能。
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