用立体定向放射外科手术治疗垂体神经内分泌肿瘤。

IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuro-Oncology Pub Date : 2024-10-28 DOI:10.1007/s11060-024-04864-3
Inhwa Kim, Michael Yan, Michel Sourour, Robert Heaton, Colin Faulkner, Aristotelis Kalyvas, Dana M Keilty, Michael D Cusimano, David Payne, Normand Laperriere, David B Shultz, Saira B Alli, Gelareh Zadeh, Derek S Tsang
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引用次数: 0

摘要

目的:垂体神经内分泌肿瘤(pituitary neuroendocrine tumors,pitNETs)是一种良性肿瘤,手术切除后可能复发,药物治疗后也可能持续存在。本研究的目的是评估单一机构采用立体定向放射手术(SRS)治疗垂体神经内分泌肿瘤患者的疗效和毒性:我们对 2005 年 9 月至 2023 年 6 月间接受基于框架、单分量、钴-60 SRS 治疗的洼地网状细胞瘤患者进行了一项单一机构的回顾性研究。主要终点是局部肿瘤控制。次要终点包括内分泌控制(功能性肿瘤)、总生存期和毒性反应:共有 83 名患者的 88 个病灶接受了 SRS 治疗。大多数病变(70%)为无功能肿瘤。在26个有功能的肿瘤中,6名患者仅通过SRS治疗(23%)就获得了内分泌缓解,其余患者通过联合药物治疗获得了缓解。患者中位随访时间为4.7年,未观察到局部肿瘤复发,估计局部控制概率为100%。两年和五年总生存率分别为97%(95%置信区间[CI] 89-99)和95%(95%置信区间[CI] 84-98)。死亡原因与PitNET或SRS无关。12名患者(14%)在SRS后出现垂体功能减退。尽管有34个病灶距离视神经结构≤3毫米,但没有患者在SRS术后出现视神经病变或视力下降:结论:SRS是一种治疗复发或残留凹陷性神经网的高效方法。本研究观察到,在中位随访 4.7 年后,局部控制率达到 100%,且无视神经毒性病例。这些观察结果表明,在未来的洼地网状细胞瘤治疗中可能会降低剂量。
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Pituitary neuroendocrine tumors treated with stereotactic radiosurgery.

Purpose: Pituitary neuroendocrine tumors (pitNETs) are benign tumors that may recur after surgical resection or persist following medical management. The objective of this study was to evaluate outcomes and toxicities of patients with pitNETs treated with stereotactic radiosurgery (SRS) at a single institution.

Methods: We completed a retrospective, single-institution study of patients with pitNETs treated with frame-based, single-fraction, cobalt-60 SRS between September 2005 and June 2023. The primary endpoint was local tumor control. Secondary endpoints included endocrine control (for functional tumors), overall survival, and toxicities.

Results: A total of 88 lesions in 83 patients were treated with SRS. Most lesions (70%) were non-functional tumors. Of the 26 functioning tumors, 6 patients achieved endocrine remission with SRS alone (23%), and the remainder achieved remission with combined medical management. With a median patient follow-up of 4.7 years, no local tumor recurrences were observed with an estimated local control probability of 100%. Two- and five-year overall survival estimates were 97% (95% confidence interval [CI] 89-99) and 95% (95% CI 84-98), respectively. Causes of death were unrelated to PitNET or SRS. Twelve patients (14%) developed hypopituitarism after SRS. Despite the 34 lesions that were ≤ 3 mm from optic structures, no patients developed any optic neuropathy or visual decline post SRS.

Conclusions: SRS is a highly effective modality for recurrent or residual pitNETs. This study observed a local control of 100% with no cases of optic toxicities after a median follow-up of 4.7 years. These observed findings suggest that dose de-escalation may be possible for future treatment of pitNETs.

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来源期刊
Journal of Neuro-Oncology
Journal of Neuro-Oncology 医学-临床神经学
CiteScore
6.60
自引率
7.70%
发文量
277
审稿时长
3.3 months
期刊介绍: The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.
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