无功能垂体大腺瘤多次切除术后立体定向放射外科治疗的相关结果：一项国际多中心病例系列研究

Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series.

作者信息

Grogan Dayton, Dumot Chloe, Mantziaris Georgios, Tos Salem M, Tewari Anant, Dayawansa Sam, Sheehan Kimball, Sheehan Darrah, Peker Selcuk, Samanci Yavuz, Nabeel Ahmed M, Reda Wael A, Tawadros Sameh R, AbdelKarim Khaled, El-Shehaby Amr M N, Emad Reem M, Abdelsalam Ahmed Ragab, Liscak Roman, May Jaromir, Mashiach Elad, Vasconcellos Fernando De Nigris, Bernstein Kenneth, Kondziolka Douglas, Speckter Herwin, Mota Ruben, Brito Anderson, Bindal Shray Kumar, Niranjan Ajay, Lunsford L Dade, Benjamin Carolina Gesteira, Almeida Timoteo Abrantes de Lacerda, Mathieu David, Tourigny Jean-Nicolas, Tripathi Manjul, Palmer Joshua David, Mao Jennifer, Matsui Jennifer, Crooks Joseph, Wegner Rodney E, Shepard Matthew J, Sheehan Jason

机构信息

Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA.

Department of Neurological Surgery, Hospices civils de Lyon, Lyon , France.

出版信息

Neurosurgery. 2024 Nov 7;97(1):182-190. doi: 10.1227/neu.0000000000003262.

DOI:10.1227/neu.0000000000003262

PMID:39508579

Abstract

BACKGROUND AND OBJECTIVES

Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections.

METHODS

Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism.

RESULTS

Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm 3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P -value = .004).

CONCLUSION

For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection.

摘要

背景与目的

立体定向放射外科（SRS）是治疗无功能垂体腺瘤（NFPA）的一种有效方法。然而，此前尚无关于多次手术切除后接受SRS治疗NFPA的结果的相关数据发表。

方法

回顾性分析多中心诊断为NFPA且在接受SRS治疗前已接受多次（≥2次）手术切除患者的数据。治疗时间跨度为1992年至2022年。采用Cox回归和Kaplan-Meier曲线评估预测因素以及肿瘤控制和垂体功能减退的概率。

结果

在311例患者（中位年龄：50.2[四分位间距：18.0]岁）中，226例（72.7%）此前接受过≥2次手术切除。中位边缘剂量为14 Gy（四分位间距：4.0 Gy），中位肿瘤体积为3.6 cm³（四分位间距：4.8）。总体而言，SRS治疗后5年和10年的肿瘤控制概率分别为93.3%（95%置信区间：89.9 - 96.9）和86.7%（95%置信区间：81.1 - 92.6）。边缘剂量>14 Gy与肿瘤进展风险降低相关（风险比 = 0.33，95%置信区间 = 0.15 - 0.75，P = 0.008）。在最后一次临床随访4.1（四分位间距6.1）年时，10.1%（30/296）的患者在SRS后出现至少1种新的激素缺乏。新激素缺乏的累积概率在SRS后3年、5年和10年分别为6.1%（95%置信区间：3.0 - 9.1）、10.3%（95%置信区间：5.8 - 14.6）和18.9%（95%置信区间：11.5 - 25.8）。SRS与新激素缺乏发生之间的平均间隔时间为3.3年（四分位间距4.1）。垂体柄最大点剂量>10 Gy与新的激素缺乏相关（风险比 = 4.06，95%置信区间 = 1.57 - 10.5，P值 = 0.004）。