垂体腺瘤的X刀治疗--附54例临床分析

目的：观察分析X刀对垂体腺瘤的治疗效果。方法：对应用Radionic公司头部X刀系统治疗的垂体腺瘤患随访54例，单次治疗32例，分次治疗22例。其中54例获得影像学复查，36例获得血激素水平复查。随访期3个月到32个月，平均13．2个月。结果：肿瘤缩小达55．6％，无1例肿瘤增大；临床症状改善率72．2％，无临床症状加重；血激素水平恢复正常达30．6％。结论：X刀治疗垂体腺瘤安全、有效，无明显副作用，SRT治疗后血激素水平恢复正常率高于SRS治疗，但血激素水平恢复时间长于SRS治疗。     

垂体腺病的X刀治疗

目的观察分析X刀对垂体腺瘤的治疗效果.方法对1997年1月至2000年6月应用Radionic公司头部X刀系统,治疗的垂体腺瘤患者随访54例,单次治疗32例,分次治疗22例.其中54例获得影象学复查,36例获得血激素水平复查.随访期3个月到32个月,平均13.2个月.结果肿瘤缩小达55.6%,无一例肿瘤增大;临床症状改善率72.2%,无临床症状加重着.血激素水平恢复正常达30.6%.结论X刀治疗垂体腺瘤安全、有效,无明显副作用,SRT治疗后血激素水平恢复正常率高于SRS治疗,但血激素水平恢复时间长于SRS治疗.     

旋转式伽玛刀治疗垂体腺瘤的初步报告

观察ＯＵＲ－ＲＧＳγ刀治疗垂体病效果。方法１９９７年１月至１９９９年６月,应用旋转式伽玛刀治疗垂体腺瘤１８４例。其中８９例获得随访,随访期６－２４个月,平均１４个月。结果肿瘤控制生长率达９７．６％。症状改善率达７６．４％,激素水平下 恢复正常达７５．５％,无死亡,无严重并发症。     

X刀治疗垂体腺瘤的疗效与方法学初探

目的总结50例X刀治疗垂体腺瘤的治疗和临床、内分泌、影像复查资料,评价X刀治疗垂体腺瘤的临床疗效,探讨X刀治疗垂体腺瘤的方法学.方法用X刀对PRL腺瘤36例,GH腺瘤5例,混合性腺瘤4例,无功能性腺瘤5例治疗.肿瘤治疗剂量19.48±3.36Gy,等中心数1.24±0.68个/例,视交叉受重＜8～9Gy.结果随访12～62月,平均32.6月,14例闭经患者恢复月经,共26例月经恢复正常,25例停止溢乳,3例患者溢乳减轻,5例患者受孕,6例患者肢端肥大改善,临床有效率96%.影像学复查肿瘤消失35例,坏死缩小12例,肿瘤控制率100%.在治疗后3～6月,可出现肿瘤坏死缩小,随时间的延长,肿瘤消失率增加,但大体积病变,肿瘤消失困难.结论X刀是一种垂体腺瘤的安全、有效的治疗手段.推荐无功能腺瘤＞12-13Gy,分泌性腺瘤20-30Gy.分次立体定向放射治疗是X刀治疗垂体腺瘤的新课题和努力方向.     

立体定向伽玛刀治疗垂体腺瘤56例报告

目的：探讨伽玛刀对垂体腺瘤的疗效。方法：５６例垂体瘤患者实施立体定向伽玛刀治疗，肿瘤直径４～３４．２ｍｍ（平均１５．６ｍｍ），肿瘤照射野覆盖平均为６７％，瘤周边剂量平均为２４Ｇｙ。结果：５１例随访３～２１个月（平均１１个月），临床症状改善３６例（７０．６％），激素水平恢复正常或下降１９／２５例（７６％），肿瘤缩小２５／４７例（５３％），仅３例肿瘤增大。结论：认为伽玛刀手术简便、安全，是治疗垂体腺瘤（尤其是微小功能性腺瘤）的又一有效方法。     

垂体腺瘤的伽玛刀治疗

目的：评价伽玛刀（γ-刀）手术对垂体腺瘤的治疗效果。方法：对292例垂腺瘤患者,用1．5T磁共振和γ-plan计算机联网定位,Leksell伽玛刀实施放射外科手术。肿瘤直径3．8－51．5mm,平均16．3mm,处方剂量9－35Gy,平均21.6Gy。结果：本组获随访204例（12－34个月,平均21个月）肿瘤消失39例（19．1％）,缩小156例（76．4％）;激素值恢复正常14例（11．8％）,较术前下降94例（79．6％）;临床症状改善190例（93．1％）,9例症状加重,3例肿瘤增大,2例开颅手术,1例死亡。结论：γ-刀是治疗垂体腺瘤安全、有效的一种方法,但要严格掌握适应证,对Ⅲ级以上瘤应首选手术治疗,γ-刀治疗后有可能加重垂体功能下或诱发垂体危象。     

泌乳素型垂体腺瘤的伽玛刀治疗

目的探讨伽玛刀治疗泌乳素型垂体腺瘤的疗效及影响疗效的因素。方法应用伽玛刀治疗47例泌乳素型垂体腺瘤，治疗周边剂量为20-35Gy，平均随访17．5个月。结果47例患者中，40例患者症状改善，36例患者肿瘤缩小。6例患者患者激素水平恢复正常。结论伽玛刀治疗泌乳素型垂体腺瘤是一种有效的治疗方法，其疗效与治疗剂量、治疗前激素水平等密切相关。     

垂体腺瘤的伽玛刀治疗

目的：评估伽玛刀（γ－刀）手术对垂体腺瘤的治疗效果。方法：对２９２例垂体腺瘤患者,用１．５Ｔ磁共振和γ－ｐｌａｎ计算机联网定位,Ｌｅｋｓｅｌ伽玛刀实施放射外科手术。肿瘤直径３．８～５１．１ｍｍ,平均１６．３ｍｍ,处方剂量９～３５Ｇｙ,平均２１．６Ｇｙ。结果：本组获随访２０４例（１２～３４个月,平均２１个月）,肿瘤消失３９例（１９．１％）,缩小１５６例（７６．４％）;激素值恢复正常１４例（１１．８％）,较术前下降９４例（７９．６％）;临床症状改善１９０例（９３．１％）,９例症状加重,３例肿瘤增大,２例开颅手术,１例死亡。结论：γ－刀是治疗垂体腺瘤安全、有效的一种方法,但要严格掌握适应证,对Ⅲ级以上肿瘤应首选手术治疗,γ－刀治疗后有可能加重垂体功能低下或诱发垂体危象。     

功能性垂体腺瘤的伽玛刀治疗

目的 评估伽玛刀（γ-刀）治疗对功能性垂体腺瘤的治疗效果。方法 对132例功能性垂体腺瘤病人,用1.5T磁共振和γ-plan计算机联网定位,LekaseⅡ,伽玛刀实施放射外科手术,肿瘤直径4-37mm,平均14mm,处方剂量11-35Gy,平均26.4Gy。结果 本组病例随访35-57个月,获随访118例（89.4%),肿瘤消失78例（66.1%),缩小32例（27.1%),肿瘤增大1例;激素值恢复正常74例（62.7%)。较术前下降26例（22.0%)。临床症状改善108例（91.5%),症状加重6例（5.1%)。结论 γ-刀是治疗功能性垂体腺瘤安全、有效的一种方法,但要严格掌握适应证,否则γ-刀治疗后有可能加重症状,产生并发症。     

垂体腺瘤的γ-刀治疗

目的评价γ-刀治疗垂体腺瘤的疗效及患者激素水平的变化,以及治疗后的主要并发症。方法对1995年9月-2004年12月经γ-刀治疗并获得完全随访的312例垂体腺瘤患者(包括手术后104例,放射治疗后35例,173例直接采用γ-刀治疗)的临床资料及疗效进行回顾性分析,其中非功能性垂体腺瘤78例,功能性垂体腺瘤234例(催乳素腺瘤124例、生长激素腺瘤37例、促肾上腺皮质激素腺瘤12例、促甲状腺激素腺瘤1例、卵泡刺激素腺瘤8例和混合性腺瘤52例)。根据患者临床症状改善程度、治疗前后肿瘤直径变化及内分泌功能等综合评价疗效。平均随访30.50个月。结果γ-刀治疗后肿瘤完全消失25例(8.01%),缩小152例(48.72%),大小无变化129例(41.35%),增大6例(1.92%),总的肿瘤控制率为98.08%(306/312)。功能性垂体腺瘤患者中77例(32.91%)激素分泌水平恢复正常,102例(43.59%)较治疗前下降,55例(23.50%)无明显改变。γ-刀治疗的晚期并发症主要有视力下降(5例)和垂体功能低下(8例)。结论γ-刀治疗垂体腺瘤患者安全、有效。     

颅内肿瘤立体定向放射外科治疗后的再手术处理

目的对脑肿瘤病人经立体定向放射外科治疗(SRS)后需再手术的原因及处理方法进行分析。方法收集病例17例,其中恶性胶质瘤5例,肺癌脑转移3例,颅咽管瘤3例,听神经瘤2例,垂体瘤2例,脑膜瘤2例。结果8例为SRS治疗后出现放疗后脑水肿或脑积水,行肿瘤切除及减压术5例,脑室-腹腔分流术3例。5例为肿瘤继续长大,3例为治疗无效,均行肿瘤切除术。1例脑脊液鼻漏行脑脊液漏修补术。治疗后病情改善15例,死亡2例。结论脑肿瘤SRS后再手术处理的主要原因是放疗后脑水肿和肿瘤生长。SRS治疗应严格掌握适应证,及时处理并发症。     

立体定向伽玛刀治疗泌乳素腺瘤

采用立体定向伽玛刀治疗垂体泌乳素瘤２７例，其中手术证实者３例，其余２４例靠影像学和内分泌学确诊。伽玛刀治疗后３个月开始对病人随访，随访时间６至１２个月。有随访结果者２３例，有影像学复查结果者１５例。结果表明病人症状控制率和肿瘤大小控制率均为１００％，并且随访１２例ＰＲＬ变化，结果７例恢复正常，４例下降，仅１例略高于治疗前，无死亡及严重并发症发生。     

Fractionated stereotactic radiosurgery using the Novalis system for the management of pituitary adenomas close to the optic apparatus

Radiosurgery has been proven to be an effective treatment for residual or recurrent pituitary adenomas after surgery. However, it causes severe complications when the optic apparatus is irradiated over the tolerance dose. In this study, we analyzed the feasibility of fractionated stereotactic radiosurgery to treat pituitary tumors close to the optic apparatus. Thirty-four patients from June 2006 to June 2011 with recurrent or residual pituitary adenomas close to (<3 mm) the optic apparatus were treated with fractionated stereotactic radiosurgery. Three fractions with a total dose of 2100 cGy were applied to the tumors. Imaging, examination of vision, and estimation of hormone level were regularly performed before and after radiosurgery. The mean tumor volume before fractioned stereotactic radiosurgery was 5.06 ± 3.08 cm³ (range: 0.82–12.69 cm³). After a mean follow up of 36.8 ± 15.7 months (range: 16–72 months), tumor size was reduced in seven (20.6%) patients and remained the same in the other 27 (79.4%) patients. Vision was improved in one patient and remained stable in the rest. Only one patient developed transient post-treatment diplopia. This study suggests that fractionated stereotactic radiosurgery is safe for treating pituitary adenomas close to the optic apparatus. Studies with more patients and longer follow-up are required to draw definite conclusions.     

表现为肾上腺皮质功能减退的垂体无功能腺瘤的诊断和治疗

目的 分析肾上腺皮质功能低下的垂体无功能腺瘤的诊断和治疗。方法 男性27例，女性15例。年龄38～73岁，平均54．2岁，平均病程4，6年。有乏力倦怠，内分泌检查24h尿游离皮质醇（UFC）低于正常，均行经蝶窦显微外科垂体腺瘤切除术。结果 随诊6个月至5年，肿瘤消失33例，7例放疗，4例行开颅手术，12例需要补充激素。结论 肾上腺皮质激素减退多发于老年病人、垂体腺瘤卒中和侵袭性垂体腺瘤，术中应保护残留垂体组织，围手术期及时补充激素。     

伽玛刀放射外科治疗垂体腺瘤的疗效评价

目的评价伽玛刀(Gamma Knife)放射外科治疗垂体腺瘤的疗效及安全性。方法对2010年1月~2013年12月期间采用OUR旋转式伽玛刀作为首选方法治疗的143例垂体腺瘤患者的临床资料进行回顾性研究,PRL型54例、GH型24例、ACTH型11例、混合型(GH+PPL)15例和无功能型(NFA)39例。肿瘤直径2 mm~64 mm(平均26.3 mm),30%~70%等剂量曲线包绕肿瘤,肿瘤平均周边剂量26.5Gy,平均中心剂量41.0Gy。对术后随访患者的临床症状、血液激素水平和鞍区MRI检查结果进行对比分析。结果随访期3~30个月,平均18月,临床症状改善或消失103例(72.0%),激素水平下降或恢复正常84例(80.8%),肿瘤缩小或消失87例(60.8%),平均肿瘤生长控制率为95.1%。结论伽玛刀放射外科对各种类型垂体腺瘤的治疗是安全有效的,能够改善和控制大部分患者的临床症状、激素水平和肿瘤生长。     

Gamma-knife for treating pituitary adenomas in 501 cases： Retrospective case analysis

BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors. OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively. DESIGN: Case-analysis. SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA. PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent. METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations. The average iso-dose curve was 50% (30%–65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms, imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation. MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications. RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms, 154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29 recovery to normal value, and of 19 not changed obviously. ② Second gamma-knife treatment: At 6–24 months after gamma-knife treatment, 15 patients with pituitary tumor received second gamma-knife treatment; especially, one patient received for the three times. The conditions in details were recorded as follows: The peri-dose for the first treatment ranged from 8 to 12 Gy; in addition, that for the second one ranged from 6 to 12 Gy. ③ Postoperative complications: The complications were as follow: hypopituitarism occurred in 2 patients (0.7%); tumor apoplexy in 2 patients (0.7%); weakened eyesight in 5 patients (1.8%); 3 of which recovered with dehydration and hormone treatment; 2 patients received tumor resection and optical nerve decompression operation with dehydration and hormone treatment ineffectively. CONCLUSION: Gamma-knife is effective and safe for pituitary adenoma.     

Single dose versus fractionated stereotactic radiotherapy for meningiomas

OBJECTIVE: To evaluate the safety and efficacy of stereotactic radiosurgery (SRS) compared to fractionated stereotactic radiation therapy (FSRT) for meningiomas treated over a seven year period. METHODS AND MATERIALS: Of the 53 patients (15 male and 38 female) with 63 meningiomas, 35 were treated with SRS and the 18 patients with tumors adjacent to critical structures or with large tumors were treated with FSRT. The median doses for the SRS and the FSRT groups were 1400 cGy (500-4500 cGy) and 5400 cGy (4000-6000 cGy) respectively. Median target volumes for SRS and FSRT were 6.8 ml and 8.8 ml respectively. The median follow-up for the SRS and FSRT groups were 38 months (4.1-97 months) and 30.5 months (6.0-63 months) respectively. RESULTS: The five-year tumor control probability (TC) for benign versus atypical meningiomas were 92.7% vs. 31% (P = .006). The three-year TC were 92.7% vs. 93.3% for SRS vs. FSRT groups respectively (P = .62). For benign meningiomas, the three-year TC were 92.9% vs. 92.3% for the SRS group (29 patients) vs. FSRT group (14 patients) respectively (P = .77). Two patients in the SRS group and one in the FSRT group developed late complications. CONCLUSION: Preliminary data suggest that SRS is a safe and effective treatment for patients with benign meningiomas. Fractionated stereotactic radiation therapy with conventional fractionation appeared to be an effective and safe treatment alternative for patients not appropriate for SRS. A longer follow-up is required to determine the long-term efficacy and the toxicity of these treatment modalities.     

伽玛刀治疗肺癌脑转移瘤的疗效及影响生存时间和预后的相关因素分析

目的探讨伽玛刀治疗肺癌脑转移瘤方面的疗效及分析与其生存时间和预后相关的因素。方法选取106例于2013年1月至2015年1月期间在本院行伽玛刀治疗的肺癌脑转移瘤患者,按照其手术方式进行分组,其中42例行立体定向放射外科(SRS)治疗,30例行立体定向放射治疗(SRT)治疗,17例行SRS联合全脑放疗(WBRT)治疗,13例行SRS/SRT挽救治疗,4例行SRS联合WBRT挽救治疗,观察患者的疗效并分析影响其生存时间和预后的相关因素。结果 106例肺癌脑转移瘤患者经伽玛刀治疗后6个月生存率为50%,各种治疗方法治疗后的生存率和中位生存期分别为61%、57%、42%、30%、2%和9、8、6、5、3个月,差异有统计学意义(P0.001);多因素Logistic回归分析的结果显示影响经伽玛刀治疗的肺癌脑转移瘤患者预后的相关因素主要有KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗(P0.05)。结论肺癌脑转移瘤使用伽玛刀治疗可获得相似的生存率;影响患者术后生存时间和预后的因素主要是KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗。     

Stereotactic radiotherapy and radiosurgery in treatment of patients with deep-seated pilocytic astrocytomas

Pilocytic astrocytoma (PA) is a low-grade glial tumor (WHO grade I) with predominant occurrence in pediatric patients. According to many authors, stereotactic radiosurgery (SRS) and radiotherapy (SRT) promote long-term remission or retardation of tumor progression in patients with in inoperable lesions after incomplete resection or recurrence. Therefore it is essential to determine the role of SRS and SRT in complex management of patients with deep-seated PA. Since April 2005 till May 2010 101 patient with intracranial PA was treated in department for radiation therapy of Burdenko Neurosurgical Institute. The series consisted of 70 pediatric patients (below 17 years inclusively) and 31 adults, of them--51 male and 50 female patients. Mean age was 15.1 years (9.8 years in children and 28.7 in adults). In 90 patients (89.2%) tumors were previously histologically verified (tumor resection in 83 cases and biopsy in 7). In 11 (10.8%) patients diagnosis of PA was based on clinical and neurovisualization data. In most cases SRT (66 (66.3%) patients) was preformed, the rest 35 (34.7%) patients were treated by SRS. Median follow-up from the onset of disease reached 52 months (2-228 months). Catamnestic data were available in 88 (87%) patients. By the end of catamnestic follow-up (December 2010) 87 (98.8%) patients treated by SRS and SRT were alive. Median follow-up from the start of radiation treatment was 22.7 months (6-60 months). Progression of tumor was observed in 20 patients (22.7%), in 18 of them due to cyst growth. 18 patients were reoperated. In 12 operated patients histological examination and its comparative analysis were performed. We found that alterations in the tumor tissue, accompanied by regression of solid component and progression of cystic portion, represent reactive-degenerative changes in the tumor as a consequence of radiation-induced pathomorphism. SRS and STR are effective techniques for treatment of patients with primary and recurrent PA despite regardless of localization of the tumor. There procedures should be performed shortly after non-radical resection. Control of tumor growth by the present time (median follow-up is 22.7 months) reaches 98%. "Progression" of the tumor due to enlargement of cystic portion shortly after SRT and SRS represents reactive-degenerative alterations in the tumor tissue and should not be evaluated as true recurrence; without neurological deterioration these cases do not require special treatment.     

A single centre's experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the Linear Accelerator (Linac)

Non-functioning pituitary adenomas are primarily a surgically managed pathology, but recurrence or regrowth is not uncommon. Previous large series have retrospectively validated the use of the Gamma Knife (GK) as an adjuvant treatment. To our knowledge, we present the largest case series to date with the Linear Accelerator (Linac) for the management of this pathology. In this study we review the clinical course of 118 patients, 51 of whom had stereotactic radiosurgery (SRS) and 67 who had fractionated stereotactic radiotherapy (FSRT); the discriminatory feature being proximity to the optic chiasm. For comparison purposes a population of 53 patients who had conventional radiotherapy (CRT) is included. The local control rates at 5 years for SRS, FRST and CRT were 100%, 93% and 87% respectively. Treatment-related morbidity was low. These data confirm that Linac SRS and FSRT are safe and effective for the treatment of non-functioning pituitary adenomas.