转移至垂体的治疗结果：21 例病理诊断病例系列。

Treatment outcome of metastasis to the pituitary gland: a case series of 21 patients with pathological diagnosis.

机构信息

1Department of Neurological Surgery.

3Division of Endocrinology, Metabolism and Nutrition.

出版信息

Neurosurg Focus. 2023 Aug;55(2):E13. doi: 10.3171/2023.5.FOCUS23185.

DOI:10.3171/2023.5.FOCUS23185

PMID:37527679

Abstract

OBJECTIVE

The aim of this study was to report the treatment course of histologically confirmed metastases to the pituitary gland (pituitary metastasis).

METHODS

The Mayo data explorer was used to find patients with pituitary metastasis. Twenty-one patients were identified between the years 2001 and 2021, and their data were retrospectively collected.

RESULTS

The most common primary cancer origin was lung in men (45%) and breast in women (33%). The median age was 66 years (IQR 56-68 years). Patients presented with headache (67% [14/21]), vision problems (86% [18/21]), anterior hypopituitarism (71% [15/21]), and arginine vasopressin deficiency (38% [8/21]). Pituitary metastases were found before the diagnosis of the primary cancer in 5 patients (24%). The mean ± SD tumor size was 2.0 ± 0.7 cm, and 90% (19/21) presented as a solitary pituitary mass with no other intracranial metastatic lesions. Common radiological features were pituitary stalk thickening (90% [19/21]), cavernous sinus involvement (71% [15/21]), and constriction at the diaphragma sellae (52% [11/21]). Transsphenoidal surgery was performed in 20 patients, and subtotal resection was most frequently attained (76% [16/21]). Fourteen patients (67%) had adjuvant radiation therapy, and 15 patients (71%) were treated with systemic therapy. The median time from surgery to the initiation of radiation therapy was 16 days (IQR 11-21 days), and that from surgery to the initiation of systemic therapy was 5.0 months (IQR 1.5-14 months). During management, headaches improved in 57% (8/14) and vision problems improved in 61% (11/18) of cases; new hypopituitarism occurred in 5 patients. Six patients developed recurrence, and the median progression-free survival was 24 months (95% CI 5.4-43 months). After recurrence, 1 patient with adenoid cystic carcinoma was treated with rescue radiotherapy twice, and 4 patients responded well to systemic therapy. The median overall survival (OS) was 25 months (95% CI 7.1-43 months). The mean OS was better in patients with neuroendocrine lung tumor (261 months) and papillary thyroid carcinoma (80 months) and worse in patients with small cell lung cancer (4 months) and unknown origin (5 months).

CONCLUSIONS

Surgery with or without adjuvant radiotherapy is effective for mass reduction, rapid symptomatic improvement of vision and headaches, and definitive diagnosis. Even after local tumor control failure, some patients still benefit from radiation and/or systemic therapy.

摘要

目的

本研究旨在报告经组织学证实的垂体转移瘤（垂体转移）的治疗经过。

方法

使用 Mayo 数据资源管理器寻找垂体转移患者。在 2001 年至 2021 年期间，确定了 21 例患者，并回顾性收集了他们的数据。

结果

最常见的男性原发癌来源为肺（45%），女性为乳腺（33%）。中位年龄为 66 岁（IQR 56-68 岁）。患者出现头痛（67%[14/21]）、视力问题（86%[18/21]）、垂体前叶功能减退（71%[15/21]）和精氨酸加压素缺乏（38%[8/21]）。5 例（24%）患者在诊断原发性癌症之前发现了垂体转移。肿瘤平均直径为 2.0 ± 0.7 cm，90%（19/21）表现为单一垂体肿块，无其他颅内转移病灶。常见的影像学特征包括垂体柄增粗（90%[19/21]）、海绵窦受累（71%[15/21]）和蝶鞍隔膜狭窄（52%[11/21]）。20 例患者接受了经蝶窦手术，最常获得的是次全切除术（76%[16/21]）。14 例（67%）患者接受了辅助放疗，15 例（71%）患者接受了全身治疗。从手术到开始放疗的中位时间为 16 天（IQR 11-21 天），从手术到开始全身治疗的中位时间为 5.0 个月（IQR 1.5-14 个月）。在治疗过程中，57%（8/14）的头痛得到改善，61%（11/18）的视力问题得到改善；5 例出现新的垂体前叶功能减退。6 例患者复发，无进展生存期的中位值为 24 个月（95%CI 5.4-43 个月）。复发后，1 例腺样囊性癌患者接受了两次挽救性放疗，4 例患者对全身治疗反应良好。总生存期（OS）的中位值为 25 个月（95%CI 7.1-43 个月）。神经内分泌肺肿瘤（261 个月）和甲状腺乳头状癌（80 个月）患者的平均 OS 较好，小细胞肺癌（4 个月）和未知来源（5 个月）患者的 OS 较差。