多次切除无功能垂体大腺瘤后的立体定向放射外科治疗效果：国际多中心病例系列。

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2024-11-07 DOI:10.1227/neu.0000000000003262

Dayton Grogan, Chloe Dumot, Georgios Mantziaris, Salem M Tos, Anant Tewari, Sam Dayawansa, Kimball Sheehan, Darrah Sheehan, Selcuk Peker, Yavuz Samanci, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled AbdelKarim, Amr M N El-Shehaby, Reem M Emad, Ahmed Ragab Abdelsalam, Roman Liscak, Jaromir May, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Douglas Kondziolka, Herwin Speckter, Ruben Mota, Anderson Brito, Shray Kumar Bindal, Ajay Niranjan, L Dade Lunsford, Carolina Gesteira Benjamin, Timoteo Abrantes de Lacerda Almeida, David Mathieu, Jean-Nicolas Tourigny, Manjul Tripathi, Joshua David Palmer, Jennifer Mao, Jennifer Matsui, Joseph Crooks, Rodney E Wegner, Matthew J Shepard, Jason Sheehan

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引用次数: 0

摘要

背景和目的：立体定向放射手术（SRS）是治疗无功能垂体腺瘤（NFPA）的有效方法。然而，目前尚未有数据显示，在既往多次切除术后对 NFPA 进行 SRS 治疗的结果：方法：回顾并分析了被诊断为 NFPA 并在 SRS 之前接受过多次切除术（≥2 次）的患者的多中心回顾性数据。治疗时间跨度为 1992 年至 2022 年。采用Cox回归和Kaplan-Meier曲线评估预测因素以及肿瘤控制和垂体功能减退的概率：在311名患者（中位年龄：50.2 [IQR：18.0]岁）中，226人（72.7%）曾接受过≥2次切除手术。中位边缘剂量为 14 Gy（IQR：4.0 Gy），中位肿瘤体积为 3.6 cm3（IQR：4.8）。总体而言，SRS术后5年和10年的肿瘤控制概率分别为93.3%（CI 95%：89.9-96.9）和86.7%（CI 95%：81.1-92.6）。边缘剂量大于 14 Gy 与肿瘤进展风险降低有关（危险比 = 0.33，CI 95% = 0.15-0.75，P = .008）。在最后4.1（IQR 6.1）年的临床随访中，10.1%（30/296）的患者在SRS后至少出现了一次新的激素缺乏。SRS后3年、5年和10年，新出现激素缺乏症的累积概率分别为6.1%（95% CI：3.0-9.1）、10.3%（95% CI：5.8-14.6）和18.9%（95% CI：11.5-25.8）。SRS与出现新的激素缺乏症之间的平均潜伏期为3.3年（IQR为4.1）。垂体柄的最大点剂量>10 Gy与新的激素缺乏症有关（危险比=4.06，CI 95% = 1.57-10.5，P值=0.004）：结论：对于既往接受过多次切除术的 NFPA 患者而言，SRS 可有效控制局部肿瘤，而且在处理这些具有挑战性的腺瘤时，延迟性垂体功能减退症的风险较低。与考虑进行第三次切除术相比，对于既往接受过两次切除术的 NFPA 患者，应坚决考虑进行 SRS。

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Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series.

Background and objectives: Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections.

Methods: Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism.

Results: Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P-value = .004).

Conclusion: For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection.

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.