垂体腺瘤的立体定向放射治疗

目的评估伽玛刀立体定向放射治疗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,照射剂量９～３５Ｇｙ,平均２１．６Ｇｙ。结果本组病例随访１２～３４个月,平均２１个月,获随访２０４例。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。结论伽玛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低功能状态,诱发垂体危象。     

X-刀治疗垂体腺瘤50例疗效分析

目的:探讨X-刀治疗垂体腺瘤的临床疗效。方法:采用WDVE-XKY808X-刀治疗系统治疗垂体腺瘤患者50例,单次治疗(SRT)30例,分次治疗(SRS)20例。50例全部获得影像学复查,其中31例获得血激素水平复查。结果:治疗后3~36个月复查MRI,病灶消失(CR)者10例(20%),病灶缩小1/2或以上(PR)者21例(42%),病灶缩小1/2或以下(NC)者15例(30%),PD4例(8%),总有效率(CR PR)达62%。临床症状改善明显,无症状加重者。血激素水平恢复正常达29%。结论:X-刀治疗垂体腺瘤是一种安全、有效的方法,无明显副作用,它不同于一般外放疗,它的治疗次数虽少而瘤体受量高,疗效肯定,但要严格掌握适应证,注意并发症,及X-刀剂量选择。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。     

Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland

We evaluated survival rates and side effects after fractionated stereotactically guided radiotherapy (SCRT) and radiosurgery in patients with pituitary adenoma.

Between 1989 and 1998, 68 patients were treated with FSRT (n = 63) or radiosurgery (n = 5) for pituitary adenomas. Twenty-six had functional and 42 had nonfunctional adenomas. Follow-up included CT/MRI, endocrinologic, and ophthalmologic examinations. Mean follow-up was 38.7 months. Seven patients received radiotherapy as primary treatment and 39 patients received it postoperatively for residual disease. Twenty-two patients were treated for recurrent disease after surgery. Mean total dose was 52.2 Gy for SCRT, and 15 Gy for radiosurgery.

Overall local tumor control was 93% (60/65 patients). Forty-three patients had stable disease based on CT/MRI, while 15 had a reduction of tumor volume. After FSRT, 26% with a functional adenoma had a complete remission and 19% had a reduction of hormonal overproduction after 34 months’ mean. Two patients with STH-secreting adenomas had an endocrinologic recurrence, one with an ACTH-secreting adenoma radiologic recurrence, within 54 months. Reduction of visual acuity was seen in 4 patients and partial hypopituitarism in 3 patients. None of the patients developed brain radionecrosis or radiation-induced gliomas.

Stereotactically guided radiotherapy is effective and safe in the treatment of pituitary adenomas to improve local control and reduce hormonal overproduction.     

Fractionated proton beam irradiation of pituitary adenomas

PURPOSE: Various radiation techniques and modalities have been used to treat pituitary adenomas. This report details our experience with proton treatment of these tumors. METHODS AND MATERIALS: Forty-seven patients with pituitary adenomas treated with protons, who had at least 6 months of follow-up, were included in this analysis. Forty-two patients underwent a prior surgical resection; 5 were treated with primary radiation. Approximately half the tumors were functional. The median dose was 54 cobalt-gray equivalent. RESULTS: Tumor stabilization occurred in all 41 patients available for follow-up imaging; 10 patients had no residual tumor, and 3 had greater than 50% reduction in tumor size. Seventeen patients with functional adenomas had normalized or decreased hormone levels; progression occurred in 3 patients. Six patients have died; 2 deaths were attributed to functional progression. Complications included temporal lobe necrosis in 1 patient, new significant visual deficits in 3 patients, and incident hypopituitarism in 11 patients. CONCLUSION: Fractionated conformal proton-beam irradiation achieved effective radiologic, endocrinological, and symptomatic control of pituitary adenomas. Significant morbidity was uncommon, with the exception of postradiation hypopituitarism, which we attribute in part to concomitant risk factors for hypopituitarism present in our patient population.     

Results of surgery and irradiation or irradiation alone for pituitary adenomas

Summary A retrospective analysis was performed on the clinical course of all patients with pituitary adenomas treated at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri. Of 212 patients treated from April 1954 through December 1982, 70 were treated with radiotherapy alone (XRT), 121 began immediate post-operative XRT (2–6 weeks) and 20 received XRT following surgical failure. Several sub-groups of adenomas were identified and analyzed, including secreting versus non-secreting adenomas (33.0% secreting) and by clinical syndrome; 27% with amenorrhea/galactorrhea, 18.4% acromegalic, Cushing's disease in 6.1% and 3.3% with Nelson's syndrome. The median follow-up time from the data of diagnosis for those patients alive at the time of last follow-up was 11.9 years (range 3.0 to 30.0 years). Actuarial overall and disease-free survival was analyzed up to 25 years. The 10-year overall and disease-free survival was 77.8 and 75.3% for those patients treated with XRT alone, 86.4 and 87.2% for those treated with immediate post-operative XRT and 100.0 and 87.5% for those who were irradiated after surgical failure. Complications related directly to XRT occurred in only five patients. One patient had documented central nervous system radionecrosis, two had visual complications, and tumor necrosis with hemorrhage occurred in the other two patients. In conclusion, overall survival for all patients did not significantly differ from an age, sex and race matched population. Control of local disease was greater for those patients receiving surgery and post-operative XRT than for those receiving XRT only. XRT salvage of surgical failures was possible. Treatment with XRT results in a low complication rate. Supported by the American Cancer Society Clinical Oncology Career Development.     

Radiotherapy for pituitary adenomas: Long-term efficacy and toxicity

Background

Radiotherapy for pituitary adenomas is an effective treatment but remains controversial due to toxicity concerns.

Materials and methods

A retrospective audit of patients referred for radiotherapy during 1974-2003 was conducted, the case records were examined and data linkage to cancer registry and hospital discharge records was performed to assess the overall survival (OS), progression-free survival (PFS) and late effects (hormone deficiency, reduced vision, second cancer and stroke).

Results

Three hundred and eighty-five patients had radiotherapy (median 45 Gy). The OS was 74% and 49%, PFS was 97% and 96%, at 10 and 20 years, respectively. No specific factors influenced local control. Additional hormone deficiencies occurred in 19% (ACTH) and 26% (TSH). Actuarial rate optic neuropathy at 10 years was 0.8%. Seventy-eight patients had a stroke, a RR for a matched Scottish population of 1.45 (CI 1.05-1.18, p = 0.03) men and 2.22 (1.56-3.08, p < 0.01) women. Four intra-cranial tumours were identified; 20-year actuarial risk 1.9% (CI 0-2.6%), a RR of 5.65 (0.53-20.77, p = 0.10) men and 9.94 (0.94-36.56, p = 0.04) women.

Conclusions

This treatment is effective with good local control rates at 20 years. A significant proportion developed hypo-pituitarism. The risk of optic neuropathy was low but risk of stroke increased, particularly in women who had slight increased risk of intra-cranial tumours.     

垂体腺瘤侵袭性与p16蛋白表达及Ki-67指数的关系

探讨Ｐ１６蛋白表达及Ｋｉ－６７指数与垂体腺瘤增殖与侵袭生物学物学特性的关系。方法：应用免疫组化染色技术检测５７例垂体腺瘤中Ｐ１６及Ｋｉ－６７蛋白的表达。结果：垂体腺瘤Ｐ１６蛋白阳性率为３１．６％,侵袭性组Ｐ１６蛋白阳性率显著氏于侵袭性组。     

神经内镜经单鼻孔-蝶窦入路直视下切除垂体瘤

目的:探讨神经内镜技术经单鼻孔-蝶窦入路切除垂体瘤的临床应用及手术技巧.方法: 对12例经CT和MRI诊断的垂体瘤患者在神经内镜经单鼻孔入路直视下予以切除.结果: 全切9例,近全切3例.术后2例出现一过性脑脊液漏,尿崩3例.4例内分泌检查正常,7例视力好转,无严重并发症发生.结论: 内镜单鼻孔经蝶窦入路切除垂体瘤具有良好的深部照明、微创、全景化视野等优点,手术创伤小,并发症少、病人恢复快.     

Intensity-modulated radiotherapy for pituitary adenomas: the preliminary report of the Cleveland Clinic experience

PURPOSE: Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of pituitary adenomas. However, there have been few published data on the short- and long-term outcomes of this treatment. This is the initial report of the Cleveland Clinic's experience. METHODS AND MATERIALS: Between February 1998 and December 2003, 34 patients with pituitary adenomas were treated with IMRT. A retrospective chart review was conducted for data analysis. RESULTS: With a median follow-up of 42.5 months, the treatment has proven to be well tolerated, with performance status remaining stable in 90% of patients. Radiographic local control was 89%, and among patients with secretory tumors, 100% had a biochemical response. Only 1 patient required salvage surgery for progressive disease, giving a clinical progression free survival of 97%. The only patient who received more than 46 Gy experienced optic neuropathy 8 months after radiation. Smaller tumor volume significantly correlated with subjective improvements in nonvisual neurologic complaints (p = 0.03), and larger tumor volume significantly correlated with subjective worsening of visual symptoms (p = 0.05). New hormonal supplementation was required for 40% of patients. Younger patients were significantly more likely to require hormonal supplementation (p = 0.03). CONCLUSIONS: Intensity-modulated radiation therapy is a safe and effective treatment for pituitary adenomas over the short term. Longer follow-up is necessary to determine if IMRT confers any advantage with respect to either tumor control or toxicity over conventional radiation modalities.     

神经内镜经单鼻孔-蝶窦入路直视下切除垂体瘤

目的：探讨神经内镜技术经单鼻孔-蝶窦入路切除垂体瘤的临床应用及手术技巧。方法：对12例经CT和MRI诊断的垂体瘤患者在神经内镜经单鼻孔入路直视下予以切除。结果：全切9例,近全切3例。术后2例出现一过性脑脊液漏,尿崩3例。4例内分泌检查正常,7例视力好转,无严重并发症发生。结论：内镜单鼻孔经蝶窦入路切除垂体瘤具有良好的深部照明、微创、全景化视野等优点,手术创伤小,并发症少、病人恢复快。     

影响垂体瘤质地的相关因素分析

目的：探讨影响垂体瘤质地的相关因素,为垂体瘤患者术前评估提供依据。方法：对43例病理证实为垂体瘤患者的临床资料进行研究,分析垂体瘤质地与肿瘤类型、大小及磁共振T2信号强度的关系。结果：垂体瘤质地与肿瘤大小、磁共振T2信号强度无关（P〉0．05）与垂体瘤类型有关（P〈0．05）。结论：非功能性垂体瘤质地通常较韧,往往会增加经鼻蝶窦垂体瘤切除术的难度,应根据具体情况选择治疗方法。     

基质金属蛋白酶MMP-9、2及其抑制物TIMP-1、2在侵袭性垂体腺瘤生物学行为中的意义

背景与目的:通常垂体腺瘤在组织学上属良性肿瘤,但仍有部分肿瘤侵犯周围组织,形成侵袭性肿瘤,垂体腺瘤侵袭的生物学机制尚不清楚。垂体腺瘤血管丰富,而血管形成与肿瘤侵袭都需要细胞外基质成份的降解和细胞移动,这一过程中基质金属蛋白酶(matrixmetalloproteinases,MMP)和它们的天然抑制物-组织金属蛋白酶抑制剂(tissueinhibitorsofmetalloproteinases,TIMP)有可能起着关键作用。本研究拟通过检测MMP-9和MMP-2及其抑制因子TIMP-1和TIMP-2在非侵袭性垂体瘤和侵袭性垂体瘤中的表达,探讨垂体腺瘤的侵袭机制。方法:收集垂体瘤手术切除标本61例,分为侵袭组(49例)和非侵袭组(12例)。采用免疫组织化学SP法检测,并根据阳性细胞占肿瘤细胞总数的比率进行半定量非参数检验分析。结果:MMP-9、TIMP-1、MMP-2和TIMP-2在侵袭性垂体瘤中表达的阳性率分别为95.9%(47/49),57.1%(28/49),75.5%(37/49),和89.8%(44/49);在非侵袭性垂体瘤中阳性率分别为100%(12/12),91.7%(11/12),66.7%(8/12)和91.7%(11/12)。TIMP-1和TIMP-2的表达在侵袭性垂体瘤组明显少于非侵袭性垂体瘤组,(P<0.05);MMP-2在侵袭性垂体瘤组有增加的趋势,但无统计学意义,(P>0.05)。结论:在垂体腺瘤的侵袭性生物学机制中组织金属蛋白酶抑制剂TIMP-1和TIMP-2有可     

影响垂体瘤质地的相关因素分析

目的:探讨影响垂体瘤质地的相关因素,为垂体瘤患者术前评估提供依据.方法:对43例病理证实为垂体瘤患者的临床资料进行研究,分析垂体瘤质地与肿瘤类型、大小及磁共振T2信号强度的关系.结果:综合治疗研究.E-mail:changliang6666@126.com 垂体瘤质地与肿瘤大小、磁共振T2信号强度无关(P>0.05)与垂体瘤类型有关(P<0.05).结论:非功能性垂体瘤质地通常较韧,往往会增加经鼻蝶窦垂体瘤切除术的难度,应根据具体情况选择治疗方法.     

经单鼻孔-蝶窦入路垂体瘤切除术并发症的防治

目的：探讨经单鼻孔-蝶窦入路行垂体瘤切除术并发症的防治。方法：对60例垂体瘤采用在手术显微镜下经单鼻孔-蝶窦入路切除术，为预防及减少并发症的发生，注意术中精细操作切除肿瘤及处理瘤腔。术后及时合理的治疗并发症。结果：60例垂体瘤手术均很顺利，出血不多，并发症少。没有发生视力恶化、颈内动脉及其分支损伤、颅神经损伤、感染、长期脑脊液漏及尿崩等严重和（或）永久性并发症，无死亡。部分病例出现一过性尿崩（12例，20％）、脑脊液漏（5例，8．3％）、蛛网膜下腔出血伴有高颅压1例（2％），经过积极治疗后均在3—8天内恢复。结论：在显微镜下经单鼻孔-蝶窦入路切除垂体腺瘤安全、省时、并发症少。术中精细操作切除肿瘤及处理瘤腔是防止及减少并发症发生的根本。术后积极合理的治疗并发症均能获得痊愈。     

X-刀治疗垂体腺瘤的疗效分析

目的　探讨X 刀治疗垂体腺瘤的疗效。方法　收集我院 1997年 1月至 2 0 0 0年 1月用FischerX 刀治疗的垂体腺瘤 48例。经MR、内分泌测定等随访 ,时间为术后 6～ 3 6个月。结果　 48例经MR随访 ,体积明显缩小 15例 ,体积缩小 2 4例 ,无变化 9例 ;2 3例功能性腺瘤中 ,激素降至正常 8例 ,有下降 10例 ,无变化 5例。结论　X 刀是治疗垂体腺瘤的一种安全、可靠、有效的治疗方法。     

大垂体肿瘤的立体定向放射治疗

目的 探讨大垂体肿瘤立体定向放射治疗(stereotatic radiotherapy,SRT)的效果和视力保护问题。方法 11例大垂体肿瘤患者,肿瘤中位直径为4 cm,2例垂体肿瘤距视神经或视交叉的距离≥2 mm,其余患者肿瘤则紧贴视神经或视交叉。本组患者用X线分次立体定向放射治疗,每次剂量为5～7 Gy,每周2～3次,总剂量为40 Gy。做计划时使80％等剂量线避开视神经或视交叉。结果 肿瘤经分次SRT后体积明显缩小90.9％(10/11),视力有改善者占90.9％(10/11)。结论 SRT治疗大垂体肿瘤是有效的,对于肿瘤距视神经或视交叉的距离≤2 mm的垂体肿瘤,只要掌握好合适的分割剂量和次数,不会出现视力障碍。     

Long-term outcomes for desmoid tumors treated with radiation therapy

PURPOSE: To evaluate long-term outcomes in patients with desmoid fibromatosis treated with radiation therapy (RT), with or without surgery. METHODS AND MATERIALS: Between 1965 and 2005, 115 patients with desmoid tumors were treated with RT at our institution. The median age was 29 years (range, 8-73 years). Of the patients, 41 (36%) received RT alone (median dose, 56 Gy) for gross disease, and 74 (64%) received combined-modality treatment (CMT) consisting of a combination of surgery and RT (median dose, 50.4 Gy). RESULTS: Median follow-up was 10.1 years. Local control (LC) rates at 5 and 10 years were 75% and 74%, respectively. On univariate analysis, LC was significantly influenced by tumor size (< or =5 cm vs. 5-10 cm vs. >10 cm) (p = 0.02) and age (< or = 30 vs. >30 years) (p = 0.02). There was no significant difference in LC for patients treated with RT alone for gross disease vs. CMT. For patients treated with CMT, only tumor size significantly influenced LC (p = 0.02). Patients with positive margins after surgery did not have poorer LC than those with negative margins (p = 0.38). Radiation-related complications occurred in 20 (17%) of patients and were associated with dose >56 Gy (p = 0.001), age < or =30 years (p = 0.009), and receipt of RT alone vs. CMT (p = 0.01). CONCLUSIONS: Desmoid tumors are effectively controlled with RT administered either as an adjuvant to surgery when resection margins are positive or alone for gross disease when surgical resection is not feasible. Doses >56 Gy may not be necessary to control gross disease and are associated with high rates of radiation-related complications.     

经单鼻孔-蝶窦入路切除垂体瘤35例分析

目的:探讨经单鼻孔-蝶窦入路显微手术切除垂体瘤的临床效果、手术方法及术后处理。方法:回顾性分析采用经单鼻孔-蝶窦入路显微手术治疗的35例垂体瘤患者的临床资料。结果:35例垂体瘤患者中,泌乳素腺瘤22例,生长激素腺瘤4例,非分泌性腺瘤9例。肿瘤全切27例,次全切除6例,大部分切除2例。术后发生电解质紊乱2例,暂时性尿崩症5例,脑脊液鼻漏1例,持续1周。没有发生视力恶化、颅神经损伤、感染、长期脑脊液漏等严重并发症,无死亡。结论:经单鼻孔-蝶窦入路显微手术切除垂体瘤具有创伤小,手术时间短,安全性高,并发症少,术后康复快,垂体功能保存率高等优点。严格把握好手术适应证和禁忌症,能使需要手术治疗的垂体瘤患者取得满意的治疗效果。     

侵袭性垂体瘤的MRI诊断与影像学特征

目的:探讨MRI对侵袭性垂体瘤的诊断价值与影像特征.方法:回顾性分析经手术病理证实的36例侵袭性垂体瘤的临床资料及其MRI表现.结果:36例侵袭性垂体瘤均向鞍区多个方向生长致周围组织结构受侵,其中以海绵窦和颅底骨质侵犯为主要特征,表现为包绕颈动脉,鞍底受侵下陷,部分肿瘤突破鞍隔,突入蝶窦等,且常伴有坏死或囊变、出血.在T1WI上肿瘤呈低、等信号及混杂信号,T2WI肿瘤呈等信号或不均匀高信号.T1WI增强扫描后肿瘤多呈不均匀强化.结论:MRI检查可清楚显示侵袭性垂体瘤形态、大小、生长方式,以及肿瘤与周围组织的关系,对临床治疗方案的制定具有重要价值.