伽玛刀治疗对垂体泌乳素腺瘤内分泌功能的影响

目的 分析不同放射剂量γ-刀治疗对功能性泌乳素(PRL)腺瘤的PRL水平的影响,判断PRL在γ-刀治疗功能性PRL腺瘤预后和指导激素替代治疗的作用.方法 回顾性分析山东淄博万杰医院和广东深圳罗湖人民医院自2004年9月至2008年3月应用γ-刀治疗的248例功能性PRL腺瘤患者的临床资料,按治疗剂量将患者分组:Ⅰ组:50 Gy≤中心剂量<60 Gy;边缘剂量:20～30 Gy;Ⅱ组:40 Gy≤中心剂量<50 Gy;边缘剂量:15～25 Gy;Ⅲ组:30 Gy≤中心剂量<40Gy;边缘剂量12～20 Gy;术前、术后1月、3月、12月采用放射免疫法检测患者血清PRL水平,术后1年、2年复查头颅MRI观察肿瘤大小的变化.结果 3组患者术前PRL水平的差异有统计学意义(p<0.05),与Ⅰ、Ⅱ组比较,Ⅲ组PRL值偏低,术后12个月与Ⅰ组比较,Ⅲ组PRL值偏高;与术前相比,3组患者术后PRL水平均降低,差异有统计学意义(P<0.05);术后1年MRI显示肿瘤缩小198例(80%);术后2年肿瘤消失203例(82%),增大19例(7.7%),无变化26例(10.4%).结论 不同剂量γ-刀治疗功能性PRL腺瘤对术后内分泌的恢复有很大的影响,中心剂量和边缘剂量(尤其是中心剂量)较高时,术后PRL易恢复正常.但远期是否会造成垂体低功需要长期随访.

Abstract：

Objective To analyze the effects of-γ-knife treatment with different dosages on level of prolactin (PRL) in patients with different sizes of functional pituitary prolactinomas, and determine an index to guide hormone replacement therapy and the prognosis of -γ-knife treatment in patients with functional pituitary prolactinomas through comparing the changes of tumor sizes and the levels of PRL before and after -γ-knife treatment. Methods A retrospective analysis of the clinical data of 248 patients with functional pituitary prolactinomas was performed; gamma knife treatment was performed on these patients from September 2004 to March 2008. We divided the patients into 3 groups: group Ⅰ (50 Gy≤central dose<60 Gy, 20 Gy＜marginal dose<30 Gy), group Ⅱ (40 Gy≤ central dose＜50 Gy, 15 Gy＜marginal dose<25 Gy) and group Ⅲ (30 Gy ≤ central dose<40 Gy, 12 Gy＜marginal dose<20 Gy). The irradiation dose on optic nerves in the 3 groups was under 9 Gy. Radioimmunoassay was employed to detect the serum PRL level before and 1, 3 and 12 months after γ-knife treatment. The changes of the tumor sizes were observed and compared with cranial MRI 1 and 2 years after -γ-knife treatment.Results Significant differences on the PRL level were noted before -γ-knife treatment between each 2 groups (P<0.05); the PRL level in group Ⅲ was lower as compared with that in group Ⅰ and Ⅱ before γ-knife treatment; however, the PRL level in group Ⅲ was higher as compared with that in group 112 months after -γ-knife treatment; the PRL level in all the 3 groups after γ-knife treatment was significantly lower as compared with that before γ-knife treatment (P<0.05). MRI showed that the tumor had 80% partial response rate (198/248) in the 1st year, 82% complete response rate (203/248) in the 2nd year, increased volume in 19 patients (7.7%) and no change in 26 patients (10.4%). Conclusion Different treatment doses of Gamma knife on functional pituitary prolactinomas has great influences on postoperative recovery of endocrine; the higher doses of the center and edge (especially center), the higher normal rate of postoperative PRL level. Whether it will cause long-term hypopituitarism needs continue follow-up.

Effect of Gamma knife treatment on level of prolactin in patients with pituitary prolactinomas

Objective To analyze the effects of-γ-knife treatment with different dosages on level of prolactin (PRL) in patients with different sizes of functional pituitary prolactinomas, and determine an index to guide hormone replacement therapy and the prognosis of -γ-knife treatment in patients with functional pituitary prolactinomas through comparing the changes of tumor sizes and the levels of PRL before and after -γ-knife treatment. Methods A retrospective analysis of the clinical data of 248 patients with functional pituitary prolactinomas was performed; gamma knife treatment was performed on these patients from September 2004 to March 2008. We divided the patients into 3 groups: group Ⅰ (50 Gy≤central dose<60 Gy, 20 Gy＜marginal dose<30 Gy), group Ⅱ (40 Gy≤ central dose＜50 Gy, 15 Gy＜marginal dose<25 Gy) and group Ⅲ (30 Gy ≤ central dose<40 Gy, 12 Gy＜marginal dose<20 Gy). The irradiation dose on optic nerves in the 3 groups was under 9 Gy. Radioimmunoassay was employed to detect the serum PRL level before and 1, 3 and 12 months after γ-knife treatment. The changes of the tumor sizes were observed and compared with cranial MRI 1 and 2 years after -γ-knife treatment.Results Significant differences on the PRL level were noted before -γ-knife treatment between each 2 groups (P<0.05); the PRL level in group Ⅲ was lower as compared with that in group Ⅰ and Ⅱ before γ-knife treatment; however, the PRL level in group Ⅲ was higher as compared with that in group 112 months after -γ-knife treatment; the PRL level in all the 3 groups after γ-knife treatment was significantly lower as compared with that before γ-knife treatment (P<0.05). MRI showed that the tumor had 80% partial response rate (198/248) in the 1st year, 82% complete response rate (203/248) in the 2nd year, increased volume in 19 patients (7.7%) and no change in 26 patients (10.4%). Conclusion Different treatment doses of Gamma knife on functional pituitary prolactinomas has great influences on postoperative recovery of endocrine; the higher doses of the center and edge (especially center), the higher normal rate of postoperative PRL level. Whether it will cause long-term hypopituitarism needs continue follow-up.