Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2023 Dec;180:e317-e323. doi: 10.1016/j.wneu.2023.09.067. Epub 2023 Sep 25.
Fractionated stereotactic radiotherapy (FSRT) is a common modality used to treat pituitary adenomas with good control rates. It is not known whether FSRT should be performed early or delayed until progression occurs. We compared FSRT in treating nonfunctional pituitary adenomas (NFPA) as an adjuvant (ADJ) or on-progression (PRG) therapy.
A retrospective review of patients who underwent FSRT for an NFPA between January 2004 and December 2022 at a single institution was performed. We compared endocrinologic, ophthalmologic, and radiographic outcomes in FSRT delivered as ADJ and PRG treatment.
Seventy-five patients were analyzed, with a median follow-up of 53 months. FSRT was administered to 35 and 40 patients as ADJ and PRG, with a median time to treatment of 5.5 and 40 months, respectively. The tumor control rate was 94.3% for ADJ and 95.0% for PRG. Treatment resulted in 4 (11.4%) versus 7 (17.5%) new endocrinopathies and 2 (5.7%) versus 1 (2.5%) new visual deficits for ADJ versus PRG. A survival analysis of time to new endocrinopathy showed no difference between the 2 cohorts. The median time from surgery to new endocrinopathy was significantly different between ADJ and PRG, at 15.5 and 102.0 months, respectively.
FSRT is effective in treating NFPA for residual and progressive tumors, with excellent tumor control rates and a low risk of developing new endocrinopathies and visual deficits. Delaying treatment delayed the development of new endocrinopathies, suggesting that observation with FSRT on tumor progression may delay the onset of hypopituitarism and maintain similar effectiveness in tumor control.
分次立体定向放射治疗（FSRT）是治疗垂体腺瘤的常用方法，具有良好的控制率。目前尚不清楚 FSRT 是应该早期进行还是等到肿瘤进展时再进行。我们比较了 FSRT 作为辅助（ADJ）或进展后（PRG）治疗治疗无功能性垂体腺瘤（NFPA）的效果。
对 2004 年 1 月至 2022 年 12 月期间在单一机构接受 FSRT 治疗的 NFPA 患者进行了回顾性分析。我们比较了作为 ADJ 和 PRG 治疗的 FSRT 的内分泌、眼科和影像学结果。
共分析了 75 例患者，中位随访时间为 53 个月。FSRT 作为 ADJ 和 PRG 分别用于 35 例和 40 例患者，治疗中位时间分别为 5.5 个月和 40 个月。ADJ 和 PRG 的肿瘤控制率分别为 94.3%和 95.0%。ADJ 组有 4 例（11.4%）和 PRG 组有 7 例（17.5%）发生新的内分泌疾病，ADJ 组有 2 例（5.7%）和 PRG 组有 1 例（2.5%）出现新的视力障碍。新发生内分泌疾病的生存分析显示，两组之间无差异。从手术到新发生内分泌疾病的中位时间在 ADJ 和 PRG 之间有显著差异，分别为 15.5 个月和 102.0 个月。
FSRT 治疗残留和进展性肿瘤的 NFPA 有效，肿瘤控制率高，发生新发内分泌疾病和视力障碍的风险低。延迟治疗可延迟新发生内分泌疾病的发生，提示 FSRT 观察肿瘤进展可能延迟垂体功能减退的发生，并保持相似的肿瘤控制效果。
