伽玛刀放射外科治疗复发性或残留垂体腺瘤后的长期肿瘤控制：一项基于人群的队列研究。
Long-term tumor control following gamma-knife radiosurgery of recurrent or residual pituitary adenomas: a population-based cohort study.
机构信息
Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
出版信息
Acta Neurochir (Wien). 2024 Nov 30;166(1):488. doi: 10.1007/s00701-024-06380-9.
BACKGROUND
Pituitary adenomas (PAs) often require adjuvant Gamma Knife radiosurgery (GKRS) due to partial resection or postoperative recurrence. The purpose of this study was to evaluate the long-term efficacy of GKRS for such cases.
METHODS
Population-based, observational cohort study of patients who underwent GKRS for postoperative residual or recurrent PAs between 1999 and 2020. We assessed long-term progression-free survival (PFS), identified predictors of tumor growth, and documented adverse radiation events (AREs).
RESULTS
147 patients were included, with a median follow-up time of 8.1 years. Following GKRS, the 5-year and 10-year PFS was 86% and 68%, respectively, with a median PFS of 18.7 years. Somatotrophic adenomas showed a significantly lower risk of tumor progression in the regression analysis (OR 0.11, p = 0.003). Hypopituitarism was the most common ARE, affecting 32% of patients.
CONCLUSION
GKRS is an effective treatment option for recurrent or residual PAs, offering substantial long-term control. However, the risk for AREs, particularly hypopituitarism, is not negligeable.
背景
由于部分切除或术后复发，垂体腺瘤 (PA) 常需辅助伽玛刀放射外科手术 (GKRS)。本研究旨在评估 GKRS 治疗此类病例的长期疗效。
方法
这是一项基于人群的、观察性队列研究，纳入了 1999 年至 2020 年间因术后残留或复发 PA 而行 GKRS 治疗的患者。我们评估了长期无进展生存率 (PFS)，确定了肿瘤生长的预测因素，并记录了不良放射事件 (AREs)。
结果
共纳入 147 例患者，中位随访时间为 8.1 年。GKRS 治疗后，5 年和 10 年的 PFS 分别为 86%和 68%，中位 PFS 为 18.7 年。在回归分析中，生长激素腺瘤显示出较低的肿瘤进展风险 (OR 0.11，p = 0.003)。垂体功能减退是最常见的 ARE，影响 32%的患者。
结论
GKRS 是治疗复发性或残留 PA 的有效选择，可提供长期的显著控制。然而，ARE 风险，尤其是垂体功能减退，不容忽视。
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