垂体腺瘤的γ-刀治疗

Gamma knife for pituitary adenomas treatment

目的评价γ-刀治疗垂体腺瘤的疗效及患者激素水平的变化,以及治疗后的主要并发症。方法对1995年9月-2004年12月经γ-刀治疗并获得完全随访的312例垂体腺瘤患者(包括手术后104例,放射治疗后35例,173例直接采用γ-刀治疗)的临床资料及疗效进行回顾性分析,其中非功能性垂体腺瘤78例,功能性垂体腺瘤234例(催乳素腺瘤124例、生长激素腺瘤37例、促肾上腺皮质激素腺瘤12例、促甲状腺激素腺瘤1例、卵泡刺激素腺瘤8例和混合性腺瘤52例)。根据患者临床症状改善程度、治疗前后肿瘤直径变化及内分泌功能等综合评价疗效。平均随访30.50个月。结果γ-刀治疗后肿瘤完全消失25例(8.01%),缩小152例(48.72%),大小无变化129例(41.35%),增大6例(1.92%),总的肿瘤控制率为98.08%(306/312)。功能性垂体腺瘤患者中77例(32.91%)激素分泌水平恢复正常,102例(43.59%)较治疗前下降,55例(23.50%)无明显改变。γ-刀治疗的晚期并发症主要有视力下降(5例)和垂体功能低下(8例)。结论γ-刀治疗垂体腺瘤患者安全、有效。

Objective To evaluate curative effect, plasma hormone level and main complications after gamma knife radiosurgery （GKRS） in patients with pituitary adenomas. Methods Among 417 patients with pituitary adenomas undergoing GKRS procedures in our medical center from September 1995 to December 2004, 312 patients achieved complete follow-up including 78 non-functional pituitary adenomas and 234 functional pituitary adenomas [124 prolactinomas, 37 growth hormone-secreting adenomas, 12 adrenocorticotropic hormone-secreting adenomas, 1 thyroid-stimulating hormone-secreting adenomas, 8 follicle-stimulating hormone adenomas, and 52 mixed adenomas]. Of 312 patients followed up （117 male, 195 female）, 139 were treated for recurrent or residual adenomas after surgery or radiotherapy. The mean follow-up period was 30.50 months. The clinical symptom, tumor diameter and endocrinal function were analyzed retrospectively. Resuits In this series, complete tumor disappearance was observed in 25 cases （8.01%）, regression in 152 cases （48.72%）, stability in 129 cases （41.35%） and enlarged tumor in 6 cases （1.92%）. The total tumor control rate was 98.08% （306/312）. Of the patients with functional pituitary adenomas, plasma hormone level was normalized in 77 patients （32.91%）, decreased in 102 patients （43.59%） and without significant changes in 55 patients （23.50%） compared to the hormone level before GKRS. GKRS was tolerated well in most cases. Acute toxicity was uncommon, but late adverse effect was noted in 5 patients with decreased visual acuity and in 8 patients with hypopituitarism. Conclusion GKRS is a safe and effective therapy in selected patients with pituitary adenomas.