旋转式伽玛刀治疗泌乳素腺瘤周边剂量的初步探讨

A PROSPECTIVE STUDY OF MARGINAL-DOSE IN THE TREATMENT OF PROLACTINOMA WITH ROTATING GAMMA KNIFE

目的 探讨旋转式伽玛刀治疗泌乳素腺瘤有关周边剂量的临床问题。方法 泌乳素腺瘤患者 2 0例 ,采用OUR -XGD型旋转式伽玛刀治疗 ,周边剂量为 2 5～ 35Gy(平均 2 8.4Gy)。治疗后随访 1年 ,观察PRL水平、肿瘤影像学变化及垂体功能、视力视野变化等并发症出现情况。统计学处理采用t检验。结果 治疗后 6个月时血PRL水平与治疗前相差有显著性 (P <0 .0 5)。肿瘤生长得到控制 ,2例出现垂体功能低下 ,治疗后 1 2个月时血PRL水平与治疗前相差有高度显著性 (P <0 .0 1 )。 1 1例肿瘤体积缩小 ,7例出现垂体功能低下 ,未见视力视野异常病例。结论 伽玛刀治疗泌乳素腺瘤时采用 2 5～ 35Gy的周边剂量在近期 (1 2个月 )可以有效控制肿瘤生长、降低血PRL水平 。

Objective To explore the clinical marginal dose in the treatment of prolactinoma with gammar knife (GK). Methods 20 cases of prolactinoma received treatment of radiosurgery with OUR-XGD rotating GK, the marginal dose being 25～35Gy (on average of 28.4Gy). Follow-up visits were carried out so as to observe PRL level and the changes in neuroimage as well as the concerning complications following the irradiation. And t test was performed statistically. Results The PRL level 6 months after the treatment was remarkably different from that before the treatment (P<0.05). All the tumors had cessation of growth except that 2 cases had hypopituitarism. 12 months after the treatment the PRL level was significantly improved (P<0.01). 11 patients had their tumor reduced and 7 patents developed hypopituitarism and no other complications were reported during the follow-up period. Conclusions Rotating-gamma-knife radiosurgery with the marginal dose of 25～35Gy seems to be effective therapy for prolactinoma in selected cases during 12 months interval which can control the tumors and depress the PRL level, but may lead to hypopituitarism in some cases.