Vladyka V, Liscák R, Subrt O, Simonová G, Novotný J
Oddĕlení stereotaktické a radiacní neurochirurgie Nemocnice Na Homolce, Praha.
Cas Lek Cesk. 1995 Sep 6;134(17):539-42.
BACKGROUND. Surgery of pituitary adenomas did not produce quite satisfactory results. Therefore radiosurgery using Leksell's gamma knife has become the most widely used method which-with the contribution of MRI-meets the most important demands of aimed irradiation: a sufficiently high dose of radiation of the tumour and minimal radiation load of functionally important surrounding structures. The objective of the investigation was to assemble experience with this therapeutic method. METHODS AND RESULTS. During the period between October 1992 and September 1994 a total of 41 patients were treated: 16 men, 12-66 years old, mean age 40.8 years; 25 women age 16-76 years, mean age 50.2 years. Female:male ratio 1.5 : 1. In 30 patients (73.2%) a microsurgical operation had preceded, in 5 (12.2%) conventional fractionated radiotherapy and in 11 patients (26.9%) primary radiosurgery. As far as the type of pituitary adenoma is concerned, it conditioned acromegaly in 30, Cushing's syndrome in 3 or Nelson's syndrome in 1, or a prolactinoma was involved (in 2 patients). In five instances the adenoma was hormonally inactive. Its localization was most frequently intrasellar (36), less frequently parasellar (5). The range of administered doses varied as regards the maximum between 12.5 and 80 Gy, the average being 46.8 Gy, to the periphery of the adenoma a dose of 10-49 Gy was administered, on average 24.7 Gy using a 50-80% isodose. The time interval after treatment is relatively short for detailed analysis or evaluation. During current evaluation the authors did not observe in any of the patients progression of the disease, and in several patients diminution of the tumour was found. Karnofski's score seemed to improve. CONCLUSIONS. Radiosurgery, using Leksell's gamma knife, is after failure of conservative and microsurgical therapeutic possibilities suitable further treatment of pituitary adenoma. In indicated cases it may be the first choice. Postirradiation follow up indicates promising effects, for more detailed evaluation a several years' interval is necessary.
背景。垂体腺瘤手术的效果并不十分令人满意。因此，使用Leksell伽玛刀进行放射外科手术已成为应用最广泛的方法，在磁共振成像（MRI）的辅助下，该方法满足了精准放疗的最重要要求：给予肿瘤足够高的辐射剂量，同时使功能重要的周围结构的辐射负荷降至最低。本研究的目的是积累这种治疗方法的经验。
方法与结果。在1992年10月至1994年9月期间，共治疗了41例患者：男性16例，年龄12 - 66岁，平均年龄40.8岁；女性25例，年龄16 - 76岁，平均年龄50.2岁。男女比例为1.5 : 1。30例患者（73.2%）之前接受过显微手术，5例（12.2%）接受过常规分割放疗，11例患者（26.9%）接受了初次放射外科治疗。就垂体腺瘤的类型而言，30例导致肢端肥大症，3例导致库欣综合征，1例导致尼尔森综合征，或涉及泌乳素瘤（2例）。5例腺瘤无激素活性。其位置最常见于鞍内（36例），较少见于鞍旁（5例）。给予的剂量范围在最大剂量12.5至80 Gy之间，平均为46.8 Gy，腺瘤周边给予的剂量为10 - 49 Gy，平均为24.7 Gy，使用50 - 80%的等剂量线。治疗后的时间间隔较短，无法进行详细分析或评估。在目前的评估中，作者未观察到任何患者疾病进展，且在数例患者中发现肿瘤缩小。卡诺夫斯基评分似乎有所改善。
结论。在保守治疗和显微手术治疗均失败后，使用Leksell伽玛刀进行放射外科手术是垂体腺瘤合适的进一步治疗方法。在特定病例中，它可能是首选。放疗后的随访显示出有希望的效果，为进行更详细的评估，需要数年的间隔时间。
