Movsas B, Movsas T Z, Steinberg S M, Okunieff P
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):599-605. doi: 10.1016/0360-3016(95)00221-J.
To analyze possible long-term effects of pituitary irradiation on visual fields and acuity.
Eighty-six patients were treated with radiotherapy for pituitary tumors at the National Cancer Institute between 1980 and 1991. Twenty-one patients had baseline preradiation and long-term follow-up visual fields. Eyes were followed with serial Goldmann or Humphrey visual field testing. Neuroradiologic correlation was made with the available brain scans. There were 12 females and 9 males with an median age of 44. Eighteen patients had hormone-secreting tumors and three had chromophobe adenomas. All but one patient with an inoperable invasive macroadenoma were irradiated after one or more transphenoidal resections or a craniotomy. The indications for radiation in the operable patients were: nine patients, partial tumor resection; nine patients, tumor recurrence; and two patients, persistent hormonal elevation after surgery. The median dose delivered was 50 Gy (45-59.4 Gy). The average field size was 6 x 6 cm (5 x 5 cm to 10 x 12.5 cm).
With a median follow-up of 48 months (14-128) after radiotherapy, 1 out of 21 patients has recurred (at 8 months) and all patients are alive. Of the 38 sighted eyes, 27 had normal visual fields before and after radiation, 7 eyes showed improvement, and 4 eyes had a stable defect, mostly in the superior temporal region. There were no cases of radiation-induced visual field or acuity deterioration. Six out of 21 patients (29%) had neurologic symptoms in follow-up, most of which appeared vascular in nature. Four patients complained of atypical migranous-like headaches that first began 1.5-3 years following treatment. One patient complained of recurrent vertical diplopia and one patient had a cerebral vascular accident 7 years following therapy. A dose-related association with these neurovascular symptoms approached statistical significance. Only 1 out of 11 (9%) patients who received doses less than or equal to 50 Gy developed these symptoms, whereas 5 out of 10 (50%) patients who received doses greater than 50 Gy developed symptoms (p2 = 0.064).
Postoperative radiation for partially resected or recurrent pituitary adenomas using megavoltage radiation, as well as modern field arrangements and fractionation, is extremely effective and safe. Ninety-five percent of patients are free of recurrence with not deterioration in the visual fields or acuities. Some patients experienced neurovascular symptoms (mostly vascular headaches) following surgery and radiation. There is a trend (p2 = 0.064) toward increased symptoms following higher radiation doses.
分析垂体放疗对视野和视力可能产生的长期影响。
1980年至1991年间，86例垂体肿瘤患者在美国国立癌症研究所接受了放射治疗。21例患者有放疗前基线及长期随访视野检查结果。通过连续的戈德曼或汉弗莱视野测试对眼睛进行随访。利用现有的脑部扫描进行神经放射学相关性分析。其中女性12例，男性9例，中位年龄44岁。18例患者患有分泌激素的肿瘤，3例患有嫌色性腺瘤。除1例无法手术的侵袭性大腺瘤患者外，所有患者均在一次或多次经蝶窦切除术或开颅术后接受放疗。可手术患者的放疗指征为：9例，肿瘤部分切除；9例，肿瘤复发；2例，术后激素持续升高。中位放疗剂量为50 Gy（45 - 59.4 Gy）。平均照射野大小为6×6 cm（5×5 cm至10×12.5 cm）。
放疗后中位随访48个月（14 - 128个月），21例患者中有1例复发（8个月时），所有患者均存活。38只视力正常的眼睛中，27只放疗前后视野正常，7只眼睛视野改善，4只眼睛有稳定的视野缺损，主要位于颞上区域。没有放疗引起的视野或视力恶化病例。21例患者中有6例（29%）在随访中出现神经症状，大多数症状本质上似乎是血管性的。4例患者抱怨出现非典型偏头痛样头痛，首次发作于治疗后1.5 - 3年。1例患者抱怨反复出现垂直性复视，1例患者在治疗7年后发生脑血管意外。这些神经血管症状与剂量的相关性接近统计学意义。接受剂量小于或等于50 Gy的11例患者中只有1例（9%）出现这些症状，而接受剂量大于50 Gy的10例患者中有5例（50%）出现症状（p2 = 0.064）。
对于部分切除或复发的垂体腺瘤，采用兆伏级放疗以及现代照射野设置和分割方式进行术后放疗极其有效且安全。95%的患者无复发，视野和视力无恶化。一些患者在手术和放疗后出现神经血管症状（主要是血管性头痛）。放疗剂量较高时症状有增加的趋势（p2 = ）。 （注：原文此处p2的值可能有误，应是p值相关计算，文档中未明确给出正确值，翻译时保留原文形式） 症状增加（p2 = 0.064）。
