垂体腺瘤放疗的放射损伤与相关因素

Radiation therapy of pituitary adenoma:radiationinjury and related factors

目的分析超高压放射治疗垂体瘤后中枢神经系统放射损伤与相关因素。材料与方法１９７５～１９９０年间采用６０Ｃｏ或直线加速器放疗的垂体腺瘤６３１例，单纯放疗或术后放疗。放疗剂量范围３９～５８Ｇｙ，每次分割量１８０～２５０ｃＧｙ。结果所有病人随访皆超过５年，垂体瘤控制率是７９．７％，其中６例有视神经损伤，８例有颞叶及鞍旁坏死。中枢神经系统放射损伤与下述因素相关：总剂量大于４８Ｇｙ，每次分割量大于２Ｇｙ，３年内多程放疗，糖尿病和高血压（Ｐ＜０．０５）。结论垂体放疗４５～４８Ｇｙ，分割数大于２５次在治疗垂体瘤中是一种有效而安全的疗法。

Purpose The radiationinjury of CNS (Central nervous system) and related factor were analysed for patients with pituitary adenoma after megavoltage radiotherapy,.Materials and Methods The 631 patients with pituitary adenoma were treated by radiotherapy alone or postoperative irradiation with 60Co teletherapy or linear accelerator during the period of 1975～1990.Radiotherapy dosage was 39 to 58 Gy at a range of 180～250cGy per fraction.Results All patients were followed up for more than 5 years.The pituitary adenoma control rate was 79.7%.Of the 631 patients ,6 patients developed optic neuropathy and 8 patients developed tumoral region radionecrosis.The radiationinjury of CNS were relative to the factors:total dosage more than 48Gy,the per fraction dose more than 2.0Gy ,the multiple radiotherapy courses within 3 years,the diabetes and high blood pressure,(P<0.05)。Conclusion We believe that radiotherapy of pituitary adenoma with 45～48Gy in 25 or more fractions can result in a high (79.7) probability of stable longterm control.