Bradley K M, Adams C B, Potter C P, Wheeler D W, Anslow P J, Burke C W
Department of Diabetes, Endocrinology and Metabolism, Radcliffe Infirmary, Oxford, UK.
Clin Endocrinol (Oxf). 1994 Nov;41(5):655-9. doi: 10.1111/j.1365-2265.1994.tb01832.x.
To determine whether the rate of tumour regrowth in patients with non-functioning pituitary tumour treated by transsphenoidal surgery and selected for observation without post-operative irradiation is acceptably low, and to identify a group of patients who could appropriately avoid pituitary irradiation.
One hundred and thirty-two patients treated by transsphenoidal surgery, of whom 98 did not undergo post-operative irradiation. These 98 were selected as having had apparently complete surgical removal, and as lacking features of tumour invasion or rapid growth; 73 of them are being followed by serial pituitary imaging to detect tumour regrowth.
Forty-two patients who have been imaged on two or more occasions or more than two years after operation have shown no sign of tumour regrowth; 25 of them have been imaged at 3 or more years after operation, 13 at more than 5 years, and 4 at more than 10 years. Eight patients have shown regrowth as judged by imaging, although only one had pressure symptoms at the time; 5 out of 6 of these recurrences were found within 5 years of operation (two cannot be timed). The unirradiated group of 73 patients showed 90% recurrence-free survival at 5 years (95% confidence limits 80-100%).
Provided that careful surgery and meticulous recall mechanisms for imaging can be ensured, patients so selected may be given the information contained in these results and offered the choice of follow-up by imaging alone, without pre-emptive irradiation. We recommend that they should be imaged 6-8 weeks post-operatively, then at either 6 or 12 months depending on the appearance, and then every 3-5 years for at least 15 years. By this means, many patient-years of good health and relative medical independence can be gained, together with some financial saving.
确定经蝶窦手术治疗且选择术后不进行放疗观察的无功能性垂体瘤患者的肿瘤复发率是否低到可接受程度，并确定一组可适当避免垂体放疗的患者。
132例接受经蝶窦手术的患者，其中98例未接受术后放疗。这98例患者被选定为手术切除明显完全，且无肿瘤侵袭或快速生长特征；其中73例通过垂体连续成像进行随访以检测肿瘤复发。
42例在术后接受两次或更多次成像或术后两年以上成像的患者未显示肿瘤复发迹象；其中25例在术后3年或更长时间成像，13例在术后5年以上成像，4例在术后10年以上成像。8例经成像判断有肿瘤复发，尽管当时只有1例有压迫症状；这些复发病例中6例有5例在术后5年内发现（2例无法确定时间）。73例未接受放疗的患者组在5年时的无复发生存率为90%（95%置信区间80 - 100%）。
只要能确保手术操作仔细且有细致的成像复查机制，可将这些结果告知如此选定的患者，并让他们选择仅通过成像进行随访，而无需预防性放疗。我们建议术后6 - 8周进行成像，然后根据情况在6个月或12个月时成像，之后每3 - 5年成像一次，至少持续15年。通过这种方式，可以获得许多患者多年的良好健康状况和相对的医疗独立性，同时还能节省一些费用。
