Long-Term Follow-Up Studies of Gamma Knife Radiosurgery for Postsurgical Nonfunctioning Pituitary Adenomas
Long-Term Follow-Up Studies of Gamma Knife Radiosurgery for Postsurgical Nonfunctioning Pituitary Adenomas
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伽玛刀放射外科治疗术后无功能垂体腺瘤的长期随访研究
DOI：
10.1016/j.wneu.2019.01.009
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发表时间：
2019-04-01
影响因子：
2
通讯作者：
Zhang, YaZhuo
中科院分区：
文献类型：
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作者：
Sun, Shibin;Liu, Ali;Zhang, YaZhuo
目的：本研究的目的是评估伽玛刀治疗术后残留和复发的无功能垂体腺瘤（NFPAs）的长期临床结局，以及伽玛刀治疗在NFPAs.METHODS管理中的作用：2000年1月至2010年12月，204例NFPAs残留或复发患者接受伽玛刀治疗。患者的中位年龄为48岁（平均48岁;范围14-79岁）。中位肿瘤体积为3.3 mL（平均值为5.2 mL;范围为0.3-26.4 mL）。中位边缘剂量为14戈伊（平均14戈伊;范围9-18戈伊）。中位最大剂量为31戈伊（平均值为30戈伊; 20-40戈伊）。中位随访时间为86个月（平均88个月，范围12-213个月）。结果：在这204例患者中，最近的随访磁共振成像研究显示，102例患者（50%）肿瘤消退，81例患者（40%）肿瘤稳定，21例患者（10%）肿瘤扩大。该队列的肿瘤控制率为90%。3、5、8、10和15年的累积无进展生存率分别为97%、95%、92%、92%和81%。37例患者（18%）发生新发垂体功能减退症，1例患者发生全垂体功能减退症。5例患者（2.5%）出现新发或恶化的视觉功能障碍，无肿瘤生长。没有新的颅神经功能障碍，并没有第二个脑tumor was identified.CONCLUSIONS：GKRS提供了高肿瘤控制和低并发症发生率，在我们的长期随访。我们建议在次全切除术后约6个月，应将早期GKRS视为残留NFPAs的常规辅助治疗。
OBJECTIVE: The aim of this study was to evaluate the long-term clinical outcomes of Gamma Knife radiosurgery (GKRS) for residual and recurrent nonfunctioning pituitary adenomas (NFPAs) after surgery and the role of GKRS in the management of NFPAs.METHODS: Between January 2000 and December 2010, 204 patients with residual or recurrent NFPAs undergoing GKRS were enrolled in this study according to the inclusion criteria. The median age of the patients was 48 years (mean, 48 years; range, 14-79 years). The median tumor volume was 3.3 mL (mean, 5.2 mL; range, 0.3-26.4 mL). The median margin dose was 14 Gy (mean, 14 Gy; range, 9-18 Gy). The median maximum dose was 31 Gy (mean, 30 Gy; 20-40 Gy). The median duration of follow-up was 86 months (mean, 88 months; range, 12-213 months).RESULTS: Of these 204 patients, the latest follow-up magnetic resonance imaging studies showed tumor regression in 102 patients (50%), tumor stability in 81 patients (40%), and tumor enlargement in 21 patients (10%). The tumor control rate of this cohort was 90%. The cumulative progression-free survival at 3, 5, 8, 10, and 15 years was 97%, 95%, 92%, 92%, and 81%, respectively. Thirty-seven patients (18%) developed new-onset hypopituitarism, with 1 patient experiencing panhypopituitarism. Five patients (2.5%) presented with new or worsening visual dysfunction without tumor growth. No new cranial nerve dysfunction was shown and no second brain tumor was identified.CONCLUSIONS: GKRS provided high tumor control and a low complication rate in our long-term follow-up. We recommend that early GKRS should be considered the routine adjuvant treatment for residual NFPAs approximately 6 months after subtotal surgical resection.