Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M
Department of Clinical Radiology, University of Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):307-14. doi: 10.1016/0360-3016(95)00071-6.
To evaluate therapeutic outcome and side effects of radiotherapy in pituitary adenomas as sole or combined treatment.
Retrospective analysis of 138 patients (74 male, 64 female) irradiated for pituitary adenoma from 1972 to 1991 was performed. Mean age was 49.7 years (15-80 years). Regular follow-up (in the mean 6.53 +/- 3.99 years) included radiodiagnostical [computed tomography (CT), magnetic resonance imaging (MRI), x-ray], endocrinological, and ophthalmological examinations. Seventy patients suffered from nonfunctional pituitary adenoma, 50 patients suffered from growth-hormone producing adenomas, 11 had prolactinomas, and 7 patients had adrenocorticotropic hormone (ACTH) producing pituitary adenomas. In 99 patients surgery was followed by radiotherapy in case of suspected remaining tumor (invasive growth of the adenoma, assessment of the surgeon, pathologic CT after surgery, persisting hormonal overproduction). Twenty-three patients were treated for recurrence of disease after surgery and 16 patients received radiation as primary treatment. Total doses from 40-60 Gy (mean: 45.5 Gy) were given with single doses of 2 Gy 4 to five times a week.
Tumor control was achieved in 131 patients (94.9%). In seven patients, recurrence of disease was diagnosed in the mean 2.9 years (9-98 months) after radiotherapy and salvaged by surgery. A statistically significant dose-response relationship was found in favor of doses > or = 45 Gy. Ninety percent of the patients with hormonally active pituitary adenomas had a benefit from radiotherapy in means of complete termination (38%) or at least reduction (52%) of hormonal overproduction. Partial or complete hypopituitarism after radiotherapy developed, depending on hormonal axis, in 12 (prolactin) to 27% (follicle-stimulating hormone FSH) of patients who had not already had hypopituitarism prior to radiation. Two out of 138 patients suffered reduction of visual acuity, which was, in part, related to radiotherapy. Both therapeutic effects and side effects occurred after a latency period of 3 months up to 9 years.
We conclude that radiotherapy of pituitary adenomas, using modern treatment planning techniques, is effective and safe. To achieve optimal tumor control, doses of 45-48 Gy (conventionally fractionated) should be applied.
评估放射治疗作为垂体腺瘤单一治疗或联合治疗的疗效及副作用。
对1972年至1991年间接受垂体腺瘤放射治疗的138例患者（74例男性，64例女性）进行回顾性分析。平均年龄为49.7岁（15 - 80岁）。定期随访（平均6.53 ± 3.99年）包括放射诊断[计算机断层扫描（CT）、磁共振成像（MRI）、X线]、内分泌及眼科检查。70例患者患有无功能性垂体腺瘤，50例患者患有生长激素分泌型腺瘤，11例患有泌乳素瘤，7例患有促肾上腺皮质激素（ACTH）分泌型垂体腺瘤。99例患者在手术后若怀疑有残留肿瘤（腺瘤侵袭性生长、外科医生评估、术后病理CT、持续激素分泌过多）则接受放射治疗。23例患者因术后疾病复发接受治疗，16例患者接受放射治疗作为初始治疗。总剂量为40 - 60 Gy（平均：45.5 Gy），单次剂量为2 Gy，每周4至5次。
131例患者（94.9%）实现了肿瘤控制。7例患者在放射治疗后平均2.9年（9 - 98个月）被诊断疾病复发，并通过手术挽救。发现剂量≥45 Gy存在统计学显著的剂量 - 反应关系。90%的激素活性垂体腺瘤患者从放射治疗中获益，表现为激素分泌过多完全终止（38%）或至少减少（52%）。放射治疗后，根据激素轴的不同，在放疗前无垂体功能减退的患者中，12%（泌乳素）至27%（促卵泡激素FSH）出现部分或完全垂体功能减退。138例患者中有2例视力下降，部分与放射治疗有关。治疗效果和副作用均在3个月至9年的潜伏期后出现。
我们得出结论，采用现代治疗计划技术进行垂体腺瘤放射治疗是有效且安全的。为实现最佳肿瘤控制，应应用45 - 48 Gy（常规分割）的剂量。
