垂体腺瘤的立体定向放射治疗

Stereotactic radiosurgery for pituitary adenomas

目的评估伽玛刀立体定向放射治疗对垂体腺瘤的治疗效果。方法对２９２例垂体腺瘤患者，用１．５Ｔ磁共振和γｐｌａｎ计算机联网定位，Ｌｅｋｓｅｌ伽玛刀实施放射外科手术。肿瘤直径３．８～５１．１ｍｍ，平均１６．３ｍｍ，照射剂量９～３５Ｇｙ，平均２１．６Ｇｙ。结果本组病例随访１２～３４个月，平均２１个月，获随访２０４例。肿瘤消失３９例（１９．１％），缩小１５６例（７６．４％）；激素值恢复正常１４例（１１．８％），较术前下降９４例（７９．６％）；临床症状改善１９０例（９３．１％），９例症状加重，３例肿瘤增大，２例开颅手术，１例死亡。结论伽玛刀是治疗垂体腺瘤安全、有效的一种方法，但要严格掌握适应证，对Ⅲ级以上肿瘤应首选手术治疗，γ刀治疗后有可能加重垂体低功能状态，诱发垂体危象。

Objective To study the therapeutic efficacy of gamma knife on pituitary adenomas. Methods 292 cases of pituitary adenomas were treated with Leksell gamma knife. For localization, 1.5 Tesla MRI was used to transmit the image from the network workstation to the gamma planning system.All tumors with diameters ranging from 3.8 to 51.1mm (mean 16.3mm) and volumes ranging from 0.043 to 17.1cm3 (mean 1.7cm3) were so treated.The peripheral doses ranged from 9 to 35 Gy (mean 21.6 Gy). Results 204 cases were followed for 1234 months(mean 21 months).The tumor disappeared in 39 cases (19.1%) and reduced in 156 cases(76.4%).The elevated hormone levels became normal in 14 cases (11.8%),and decreased in 94 cases (79.6%).The clinical symptoms and signs were improved in 190 cases (93.1%),but in 9 cases they became worse. In three cases, the tumor volume was enlarged. Two cases were operated with one operative mortality. One case died. Conclusions Gamma knife radiosurgery is safe and effective methods in the treatment of pituitary adenomas.Complications of hypopituitism may occur.