Khaleghi Mehdi, Finger Guilherme, Wu Kyle C, Munjal Vikas, Ghalib Luma, Kobalka Peter, Blakaj Dukagjin, Dibs Khaled, Carrau Ricardo, Prevedello Daniel
Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
The Ohio State University College of Medicine, Columbus, OH, USA.
Pituitary. 2024 Apr;27(2):213-229. doi: 10.1007/s11102-023-01367-8. Epub 2024 Jan 25.
To explore the potential role of focused radiotherapy in managing the lymphocytic hypophysitis (LH) refractory to medical therapy and surgery.
A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution.
The study included eight patients, three from our institution and five from existing literature. The age at presentation ranged from 37 to 75 years old, with a median age of 58. The presenting symptoms involved headache in seven patients and diplopia in two patients. Pre-radiation visual field defects were noticed in four patients. All patients exhibited variable degrees of hypopituitarism before radiation, with oral corticosteroids being the initial medical treatment. Immunosuppressive therapy was attempted in two patients prior to radiation. Seven patients had a history of transsphenoidal surgery with a histologically confirmed LH. Three patients underwent stereotactic radiosurgery (SRS), while the remaining received FSRT, with a mean irradiation volume of 2.2 cm. A single-session total dose of 12 -15 Gy was administered in the SRS group. In the FSRT group, doses ranged from 24 to 30 Gy with a median dose of 25 Gy, delivered in 2 Gy fractions. Four patients achieved a resolution of visual field defects, while another two patients demonstrated improvement in their associated focal neurologic deficits. No change in pre-existing endocrine status was shown after radiation, except in one patient. Clinical response was achieved in seven patients after a single course of radiation, while one patient required the second course. Six patients remained stable on low-dose glucocorticoid during at least a 12-month follow-up period, and one discontinued it entirely without experiencing relapse. Three patients demonstrated a complete radiologic response, while the remaining showed a partial radiologic response.
Focused radiation, including FSRT, can play a role in symptomatic relief, effective mass shrinkage, and minimizing radiation exposure to critical surrounding structures in patients with refractory LH. However, further research efforts are necessary to better clarify its effects and optimal dose planning.
探讨立体定向放射治疗在治疗药物治疗和手术治疗无效的淋巴细胞性垂体炎（LH）中的潜在作用。
按照PRISMA指南进行系统的文献综述，以确定垂体炎放射治疗的相关研究以及我们机构的经验。
该研究纳入了8例患者，其中3例来自我们机构，5例来自现有文献。患者就诊时的年龄在37至75岁之间，中位年龄为58岁。主要症状包括7例患者出现头痛，2例患者出现复视。4例患者在放疗前出现视野缺损。所有患者在放疗前均表现出不同程度的垂体功能减退，初始药物治疗为口服糖皮质激素。2例患者在放疗前尝试了免疫抑制治疗。7例患者有经蝶窦手术史，组织学确诊为LH。3例患者接受了立体定向放射外科治疗（SRS），其余患者接受了分次立体定向放射治疗（FSRT），平均照射体积为2.2 cm。SRS组单次总剂量为12 - 15 Gy。在FSRT组中，剂量范围为24至30 Gy，中位剂量为25 Gy，分2 Gy分次给予。4例患者的视野缺损得到缓解，另外2例患者的相关局灶性神经功能缺损有所改善。放疗后，除1例患者外，其余患者既往的内分泌状态均无变化。7例患者在接受一个疗程的放疗后取得了临床缓解，1例患者需要第二个疗程。6例患者在至少12个月的随访期内，低剂量糖皮质激素治疗保持稳定，1例患者完全停用且未复发。3例患者显示出完全的影像学缓解，其余患者显示出部分影像学缓解。
包括FSRT在内的立体定向放射治疗可在难治性LH患者的症状缓解、有效缩小肿块以及减少对周围关键结构的辐射暴露方面发挥作用。然而，需要进一步的研究来更好地阐明其效果和最佳剂量规划。
