生长激素型垂体瘤伽玛刀治疗的初步结果

应用伽玛（γ）刀治疗34例生长激素（GH）型垂体瘤。其中8例为术后和（或）放疗后复发，其余26例为原发。8例合并高血糖，5例合并高血压。肿瘤最大经6～25mm，平均13mm。放疗后复发者肿瘤周边剂量平均16Gy，其余28例周边剂量平均30Gy。结果：随访31例，平均随访16月。肢端肥大症状改善26例（83％）；GH明显下降者20例，其中12例恢复正常；8例伴有高血糖者，3例血糖恢复正常。17例肿瘤缩小，其余肿瘤无变化。结论：初步结果表明：①单纯GH升高的垂体瘤，周边剂量大于25Gy，取得显著疗效；②合并高血糖和高血压者，周边剂量大于30Gy才能取得较好疗效；③近期无垂体功能低下。

GAMMA KNIFE RADIOSURGERY IN THE TREATMENT OF GROWTH HORMONE-PRODUCING PITUITARY ADENOMAS: PRELIMINARY RESULTS

PURPOSE To assess the effects of gamma knife radiosurgery on growth homone-producing pituitary adenomas with the magnetic resonance imaging stereotactic localization.METHODS Between October 1993 and April 1995, thirty-four patients (25 males and 9 females)with growth hormone-producing pituitary adenomas and acromegaly, were treated with gamlna knife radiosurgery- Eight patients were recurrent tumors after pituitary surgery and / or radiation therapy, and the rest 26 patients were initially treated by gamma knife after failing to respond to medical therapy. Of all patients, eight with hyperglycemia, five with hypertention. The maximum diameter of the tumors ranged from 6 to 25 mm, with mean 13 mm. The mean marginal dose administered to the patients with previous ra-diation therapy was 16 Gy(13.5 ~ 19.5Gy). The marginal dose given to previous untreated or those who only underwent surgery were 20 to 35 Gy (mean 30 Gy).RESULTS Thirty one patients have been followed from 9 to 26 months (mean l6 months). The remis-sion of the acromegaly was obtained in 26 patients, sixteen of them with significant improvement. Twentypatients attained reduction of GH leve1, l2 of them returned to normal. Three of eight patients withhyperglycemia resumed their normal blood glucose. Tumors reduced in volume in seventeen, almost disap-peared in ten. The rest were at least cessation of growth.CoNCLUSIONS The preliminary results demonstrate that: (1) the patients only with increased GHlevel and acromegaly, when marginal dose given more than 25 Gy, attained control of tumors andendocrinopathy, and improvement of clinical status; (2) more than 30 Gy given to tumor margin appearedto be effective in improving clinical status of the patients with hyperglycemia, and reducing high blood glu-cose level and hypertention, (3) there was no pituitary insuffciency complicated during the follow-up peri-od of time.