Temozolomide cytoreductive treatment in a giant cabergoline-resistant prolactin-secreting pituitary neuroendocrine tumor
Temozolomide cytoreductive treatment in a giant cabergoline-resistant prolactin-secreting pituitary neuroendocrine tumor
复制标题
DOI：
10.1097/cad.0000000000000768
复制
发表时间：
2019-06-01
影响因子：
2.3
通讯作者：
Scaroni, Carla
中科院分区：
文献类型：
--
作者：
Ceccato, Filippo;Lombardi, Giuseppe;Scaroni, Carla
多巴胺激动剂(DA，尤其是卡麦角林)被推荐作为分泌催乳素的垂体腺瘤患者的一线治疗药物，以减少激素分泌和肿瘤大小。建议对无反应的患者进行垂体手术，但不能实现大体全切除，或者在某些情况下不可行。替莫唑胺(TMZ)已被建议用于对常规治疗无效的侵袭性垂体神经内分泌瘤(PITNETs)患者。我们报告一位47岁男性患者，他有一个巨大的(70x51x64毫米)分泌催乳素的垂体网。卡麦角林治疗(最初1.5 mg/周，3个月后增加到3.5 mg/周)实现了催乳素抑制；然而，磁共振显示质量稳定。在解释了手术并发症后，病人拒绝了手术。因此，在一次垂体多学科小组会议上讨论了一种主要的新辅助细胞还原TMZ治疗，并将其添加到卡麦角林中。经过13个周期的TMZ(治疗1年)，我们观察到垂体网显著减少(从18厘米(3)的腺瘤到6厘米(3)的坏死组织)。停用TMZ后4个月、12个月和18个月进行的MRI检查显示Pitnet残留稳定，卡麦角林每周1.5毫克一直持续到今天。最近，发展垂体瘤卓越中心的标准被提出，表明多学科团队是对患者最好的护理。手术被患者拒绝，只能实现部分切除；因此，我们决定联合使用TMZ和卡麦角林。可以考虑在某些病例中早期启动TMZ，特别是在手术只能部分有效的情况下。
Dopamine agonists (DAs, especially cabergoline) are recommended as first-line treatment in patients with prolactin-secreting pituitary adenomas, to reduce hormone secretion and tumor size. Pituitary surgery, suggested in nonresponsive patients, cannot achieve a gross total resection or is not feasible in some cases. Temozolomide (TMZ) has been proposed in patients with aggressive pituitary neuroendocrine tumors (PitNETs) who do not respond to conventional treatments. We present a 47-year-old man with a giant (70x51x64 mm) prolactin-secreting PitNET. Cabergoline treatment (at first 1.5 mg/week, and then increased to 3.5 mg/week after 3 months) achieved prolactin suppression; however, magnetic resonance revealed a stable mass. After explanation of surgical complications, the patient rejected the procedure. Therefore, a primary neoadjuvant cytoreductive TMZ treatment was discussed during a meeting of the Pituitary Multidisciplinary Team, and added to cabergoline. After 13 cycles of TMZ (1 year of treatment), we observed dramatic reduction of the PitNET (from 18 cm(3) of adenoma to 6 cm(3) of necrotic tissue). MRI performed 4, 12, and 18 months after TMZ discontinuation revealed a stable residual PitNET, and 1.5 mg/week of cabergoline has been continued until today. Recently, the criteria for developing Pituitary Tumors Centers of Excellence have been proposed, indicating that a multidisciplinary team is the best care for patients. Surgery, rejected by the patient, could only achieve a partial resection; therefore, we decided to combine TMZ and cabergoline. An early initiation of TMZ could be considered in selected cases, especially when surgery could be only partially effective.