Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus
Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus
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DOI：
10.3171/sup.2006.105.7.37
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发表时间：
2006-12-01
影响因子：
4.1
通讯作者：
Shibamoto, Yuta
中科院分区：
文献类型：
--
作者：
Mori, Yoshimasa;Kobayashi, Tatsuya;Shibamoto, Yuta
对象。转移到脑垂体和海绵窦偶尔发生。这种性质的转移瘤是有问题的，因为它们毗邻重要的结构，如脑神经，包括视神经和眼外运动和面部感觉神经。据报道，只要肿瘤不大，立体定向放射手术对于脑实质不同部位的转移瘤是安全有效的。放射外科手术可以对精确定义的目标进行治疗，并且降低了辐射对周围结构产生副作用的风险。评价伽玛刀手术治疗垂体及海绵窦转移瘤的效果。在623例接受GKS治疗的脑转移患者中，13例（2.1%）发生垂体和/或海绵体转移。原发恶性肿瘤包括肺癌（5例）、乳腺癌（2例）、腮腺癌（2例）、肾细胞癌、甲状腺癌、鼻癌和胃肠道间质瘤（各1例）。4例肿瘤位于垂体（1型），5例位于海绵窦（2型），4例位于海绵窦和鞍区（3型）。患者的症状包括垂体功能障碍（2例）、视觉障碍（4例）、动眼肌麻痹（1例）、外展麻痹（5例）、三叉神经功能障碍（5例）。垂体转移瘤的边缘剂量为12 ~ 12.3 Gy。海绵状病变的边缘剂量为14.4 ~ 20 Gy。剂量的选择取决于肿瘤与脑神经的空间关系。13例患者中有9例获得了GKS后2 - 12个月（中位4个月）的影像学和临床随访数据。3个垂体和/或海绵状瘤大小稳定，6个肿瘤消失或缩小；这6例患者的视功能、眼外运动和面部感觉均得到了完全或部分的改善。这些初步结果似乎表明，GKS是一种安全有效的治疗垂体和海绵体转移的方法，因为它对实质转移有效，并能迅速改善一些患者的症状。
Object. Metastases to the pituitary gland and cavernous sinus occasionally occur. Metastases of this nature are problematic because they are adjacent to eloquent structures such as cranial nerves, including the optic pathways and nerves for extraocular movement and facial sensation. Stereotactic radiosurgery has been reported to be safe and effective for metastases in various sites of brain parenchyma, providing the tumors are not large. Radiosurgery can be performed to treat a precisely defined target, and the risk of radiation side effects on the surrounding structures is reduced. The results of Gamma Knife surgery (GKS) for the treatment of metastases in the pituitary gland and the cavernous sinus are evaluated.Methods. Among 623 patients with brain metastases treated by GKS, 13 patients (2.1%) had pituitary and/or cavernous metastases. The primary malignancies included lung cancer (five cases), breast cancer (two cases), parotid cancer (two cases), renal cell carcinoma, thyroid cancer, nasal cancer, and gastrointestinal stromal tumor (one case each). The location of the tumors was the pituitary gland (Type 1) in four patients, the cavernous sinus (Type 2) in five patients, and both the cavernous sinus and the sellar region (Type 3) in four patients. The patients' symptoms included dysfunction of the pituitary gland (two patients), visual disturbance (four patients), oculomotor palsy (one patient), abducent palsy (five patients), and trigeminal dysfunction (five patients). A margin dose of 12 to 12.3 Gy was delivered to pituitary metastases. A margin dose of 14.4 to 20 Gy was delivered to cavernous lesions. The dose selection depended on the spatial relationship between tumors and the cranial nerves. Imaging and clinical follow-up data have been obtained in nine of 13 patients for 2 to 12 months (median 4 months) after GKS. Three pituitary and/or cavernous tumors are stable in size, and six tumors have disappeared or decreased in size; full or partial improvement of visual function, extraocular movement, and facial sensation have been achieved in these six patients.Conclusions. These preliminary results seem to indicate that GKS is a safe and effective treatment for pituitary and cavernous metastases, as it is effective for parenchymal metastases and promptly improved some patients' symptoms.