X刀治疗垂体腺瘤的疗效与方法学初探

Efficacy of X-knife on pituitary adenoma and preliminary study of methodology

目的:评价X刀治疗垂体腺瘤的疗效,探讨其治疗方法。方法:X刀治疗垂体腺瘤50例,含 PRL腺瘤 36例,GH 腺瘤 5例,混合性腺瘤 4例,无功能腺瘤 5例。肿瘤直径 1.43±0.32cm,治疗剂量 19.48±3.36Gy。结果:随访 32.60±14.97月,月经恢复 14例,正常 26例,溢乳停止 25例,受孕5例,肢端肥大改善6例,临床有效率96％。过度分泌激素正常14例,降低25例,激素改善率100％。肿瘤消失35例,坏死缩小 12例,肿瘤控制率 100％。结论:X刀是垂体腺瘤安全、有效的治疗手段,肿瘤治疗剂量及分次治疗是其研究课题。高分泌性腺瘤和大腺瘤宜采用多靶点、分次和配合药物治疗。

Objective: To evaluate the efficacy of X-knife on pituitary adenoma, and study the treat-ment methodology.Methods: The data of 50 patients with pituitary adenomas, treated with X-knife andfollowed up more than one year, are analyzed. This included 36 prolactinomas, 5 growth hormone(GH)se-creting adenomas, 4 mixed-functional adenomas and 5 nonfunctional adenomas. The tumor diameter was1.43±0.32cm. The prescription dose was 19.48±3.36Gy. Results: After a follow-up of 32.60±14.92months, 14 patients regained menstruation,26 patients had eumenorrhea, 25 patients stop lactating, 5 pa-tients achieved pregnancy and 6 patients experienced resolution of acromegalia.The clinical improvementrate was 96%. The over-secreting hormones were normalized in 14 cases,and decreased in 25 cases. Thehormone improvement rate was 100% .The imaging follow-up indicated that the tumors were vanished in35 cases, necrotic and shrinking in 12 cases. The local tumor control was 100%. Conclusion: X-knife issafe and effective as the therapeutics for pituitary adenoma. The optimal prescription dose and fractionatedstereotactic radiotherapy (FSRT) on pituitary adenoma are in needs of further study. The multi-target,FS-RT and combined pharmacotherapy are suitable for the excessive secreting pituitary adenomas and thelarge ones.