632例垂体腺瘤放射治疗的回顾性分析

背景与目的：放射治疗作为垂体腺瘤的辅助治疗，常用于不适宜手术或者手术未彻底切尽的患者。尽管各类腺瘤所用放射治疗的剂量在文献报告中无大区别，但是放射治疗对各类腺瘤的疗效不全一致，本文回顾性分析632例垂体腺瘤放射治疗的结果，探讨放射治疗剂量在垂体腺瘤治疗中与疗效、并发症以及复发之间的关系。方法：回顾性分析我院放射治疗科1954～1989年间收治的632例垂体腺瘤病例，其中男性302例，女性330例，中位年龄41岁。手术后病理证实的垂体生长激素腺瘤158例，垂体泌乳素腺瘤130例，垂体促肾上腺皮质细胞腺瘤93例。手术后加放疗381例，单纯放疗251例。放射治疗中位剂量49．24 Gy。结果：随访5年后接受放射治疗的垂体生长激素腺瘤、垂体泌乳素腺瘤和垂体促肾上腺皮质细胞腺瘤的总有效率分别为95．5％、86．6％和83-3％，放疗剂量在垂体腺瘤治疗中与疗效、并发症以及复发之间均有相关性。结论：垂体腺瘤放疗剂量控制在45～50 Gy，既可以取得较好的疗效，又能够避免并发症的发生。

Radiation Therapy for Pituitary Adenomas: Analysis of 632 Cases

BACKGROUND & OBJECTIVE: Radiotherapy used to be a conventional treatment for pituitary adenomas. This study was to analyze the relationship between the dosage and the efficacy, complications of radiotherapy and recurrence of tumors in 632 pituitary adenoma patients in Peking Union Medical College Hospital, Peking Union Medical College. METHODS: We reviewed the records of 632 patients with pituitary adenomas, who were first treated between 1954 and 1989, and has been followed for more than 2 years (median 6.4 years). Of these patients, 381 with pathologically confirmed pituitary adenomas received postoperative radiotherapy, and 251 received radiotherapy alone. The median total dose was 49.24Gy. Clinical symptoms related to mass effects or endocrine hypersecretion were assessed. The efficacy and the complications of radiotherapy were evaluated before treatment and during the follow-up period (2-27 years, median 6.4 years) by estimating tumor size on computed tomography or magnetic resonance imaging, as well as by endocrine testing. Local control rate, prognostic factors, and side effects were analyzed. RESULTS: The 5-year efficacy rates were 95.5%, 86.6%, 83.3%, for growth-hormone-secreting adenoma, prolactinoma, and Cushing's disease, respectively. There was significant relationship between the efficacy and the radiotherapy dosage. CONCLUSIONS: We conclude that the conventional external radiotherapy with 45-50 Gy is safe and sufficient to control pituitary adenomas.