伽玛刀放射外科治疗术后残留或复发无功能型垂体腺瘤的多中心临床分析

Gamma Knife radiosurgery for postsurgical residual or recurrent nonfunctioning pituitary adenomas: a multicenter study

摘要:

目的 多中心临床研究分析伽玛刀治疗术后残留或复发无功能型垂体腺瘤（NFPA）的长期临床疗效及在综合治疗中的地位。方法 收集4家医院的伽玛刀中心2000年1月—2015年1月诊治符合纳入标准的患者451例，其中男219例（49%），女232例（51%），年龄13~79岁，中位年龄50岁。中位肿瘤体积为4.0 cm³（0.79~55.3 cm³），中位周边处方剂量14Gy（8~21Gy），中位中心处方剂量30Gy（16~42Gy）。结果 所有患者治疗后均定期随访，随访6~213个月，中位随访时间50个月。肿瘤控制率94%（424/451），3、5、8、10年和15年的累积肿瘤控制率分别为95%（431/451）、93%（419/451）、92%（415/451）、88%（397/451）和80%（361/451）。垂体功能减退率22%（99/451）。视神经功能障碍发生率8%（36/451），外展神经功能障碍1.3%（6/451），动眼神经功能障碍1%（5/451）。结论 临床多中心研究显示，伽玛刀治疗外科术后残留或复发的NFPA安全有效，可以被作为一线治疗考虑。

Abstract:

Objective To evaluate the long-term clinical outcomes of Gamma Knife surgery (GKS) for residual or recurrent non-functioning pituitary adenomas (NFPAs) after surgery and the role of GKS in the management of NFPAs via a multicenter study. Methods Between Jan 2000 and Jan 2015, 451 patients with postsurgical residual or recurrent NFPAs undergoing GKS from four gamma knife centers were enrolled in this study according to the inclusion criteria. Of them, 219 were male and 232 were female. Their ages ranged from 13 to 79 years old with a median age of 50. The median tumor volume was 4.0 m³ (0.79~55.3 m³). The median margin dose was 14Gy (8~21 Gy), and the median maximum dose was 30Gy (16~42 Gy). Results The median duration of follow-up was 50 months (6~213 months). The tumor control rate of this cohort was 94%. The cumulative tumor control rates of 3-, 5-, 8-, 10-, and 15-year were 95%, 93%, 92%, 88%, and 80% respectively. The rate of new onset hypopituitarism was 22%. The rates of new or worsening visual dysfunction, the abducens nerve dysfunction, and the oculomotor nerve dysfunction were 8%, 1.3%, and 1% respectively. Conclusion From the multicenter study, GKS provides a high tumor control and a low complication rate for postsurgical residual or recurrent NFPAs, and should be considered as the routine adjuvant treatment of residual or recurrent NFPAs after surgery.