立体定向放射外科治疗垂体泌乳素瘤

用直线加速器放射科(X刀)治疗16例垂体催乳素瘤。女性15例,男性1例,平均年龄27.5岁。曾用过溴隐亭治疗。采用MRI扫描确定腺癌的大小,CT扫描用于立体定向靶点定位、腺瘤的直径都限于4～10mm,与视交叉的间距为2～5mm。用5或7.5mm准直器,最大剂量20～25Gy。治疗后随访12个月、结果为:7例病人临床症状缓解,PRL恢复至20～25ng/ml;6例获改善,PRL降至40～100ng/ml;3例病人无变化,PRL>200ng/ml。MRI扫描发现11例病人瘤体消失或缩小,5例瘤体直径无变化。治疗前视力、视野正常者未发现治疗后的视觉功能损害,而3例已有视力视野损害的病人有2例治疗后获改善。结果表明,直线加速器放射外科是可供治疗垂体微腺瘤选择的有效而无创的手段。

TREATMENT OF PROLACIN-PRODUCING PITUITARY TUMORS BY LINAC RADIOSURGERY

16 patients with prolactin - producing pituitary adenomas were treated by linac radio-surgery. The levels of their PRL were over 20()ng/ml before radiosurgery and they had been treated with bromocriptine. MRI scan was used to determine the extension of the adenomas and the position of chiasma of the optic nerves. All adenomas were within 4 to 10mm in diameter and at least 2 to 5mm away from the optic nerve chiasma. CT scan was used to determine stereotactic target. The maximal radiation dose was 20 to 25Gy with 5 or 7. 5mm collimator. All patients were followed up for 12 months after radiosurgery. Among them, 7 ones had complete clinical remission with near normal PRL level (20-50ng/ml), 6 ones had some clinical and endocrine improvement (40-100ng/ml PRL) and 3 ones had not any improvement. Based on MRI image, the adenomas of 11 patients regressed completely or decreased in the size and 5 ones had no change. The vision of the patients with normal vision did not change. 2 of 3 cases with visual impairment, their vision improved. It is suggested that stereotactic radiosurgery with linear accelerator can be used to treat prolactin -producing pituitary tumors as a non-invasive therapeutic alternative.