侵袭海绵窦垂体腺瘤的伽玛刀治疗

Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus

目的评价伽玛刀治疗侵袭海绵窦垂体腺瘤的疗效和内分泌激素变化,并分析了治疗后主要的并发症。方法选择了自1995年9月至2006年1月收治的并获得完全随访资料的128例侵袭海绵窦垂体腺瘤患者,肿瘤直径1.0～4.8 cm(平均3.04 cm),既往手术63例,具有放疗史22例。PRL腺瘤56例,GH腺瘤19例,ACTH腺瘤2例,FSH腺瘤1例,混合性腺瘤22例,无功能性腺瘤28例。采用Leksell立体定位系统,边缘剂量12～35 Gy(平均19.56 Gy),等剂量线45%～50%。平均随访时间34个月。结果大部分病人均可耐受伽玛刀治疗,急性并发症很少出现。晚期并发症主要表现为视力下降和垂体功能低下。伽玛刀治疗后,肿瘤消失的为4例,肿瘤缩小的为94例,肿瘤大小无变化的26例,4例患者治疗后肿瘤增大,总的肿瘤控制率为96.87%。同时对于功能性腺瘤,于治疗后11例激素水平恢复正常,58例患者激素水平较治疗前下降。结论伽玛刀治疗侵袭性垂体腺瘤是一种安全、有效的治疗方法。

Objective In recent years, gamma knife radiosurgery （GKRS） has emerged as an important treatment modality in the management of pituitary adenomas. The purpose of this study was to determine the efficacy of GKRS treatment of pituitary adenomas that have invaded the cavernous sinus; meanwhile, the main complications of this procedure are reviewed. Methods Between September 1995 and January 2006, a total of 196 patients with pituitary adenomas invading the cavernous sinus underwent GKRS procedures in our medical center and 128 patients had achieved complete follow--up materials （including serial imaging studies, clinical and endo- crine evaluations）. Part of the patients was treated for recurrent or residual disease after surgery or radiotherapy. The non--functional adenomas includes 28 patients, and 100 patients had func- tional adenomas. This latter subset of patients included 56 prolactinomas （56%）, 19 growth-- hormone secreting tumors （19%）, 2 adrenocorticotropic hormone-secreting tumors （2%） and so on. The prescription radiation dose was 12-35 Gy （mean 19.56 Gy）defined to the 45%-50%isodose line. The mean follow--up periods were 34 months. Results GKRS was tolerated well in most of these patients; acute toxicity was uncommon. I.ate toxicity was noted in five patients with visual acuity decreased and in eight patients harbored hypopituitarism. In our series, we observed that tumor regression in 94 cases, stability in 26 cases, and tumor volume increased in 4 cases, total tumors control rate was 96. 87%. Meanwhile, of the patients with hormone-secreting tumors, 11 had normalization of hormone level and 58 patients with decreased hormonal level. Conclusion GKRS is a safe and effective therapy in selected patients with invasive pituitary adenomas. Longer follow-up is required for a more complete assessment of late toxicity and treatment efficacy.