残留及复发垂体腺瘤的放射外科治疗

O. Voznyak, O. S. Silaieva, M. Polishchuk, N. Hryniv
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摘要

目的:评价垂体次全切除及复发性腺瘤不同放疗和放外科治疗方法的疗效。材料和方法。对21例垂体腺瘤进行回顾性分析。其中包括11名女性和10名男性。平均年龄为45岁(18 - 72岁)。所有患者术后均有复发或肿瘤残留。照射的方法是由一位放射科医生选定的。肿瘤大小控制由独立放射科医生在治疗后3个月和1年进行评估。在治疗后3个月和1年由独立内分泌专家评估内分泌功能。经蝶窦切除后13例(2次手术4例),颅脑手术5例,经鼻、经颅连续手术3例。14例残余肿瘤的放射治疗不迟于术后6个月。复发性腺瘤的平均治疗开始时间为术后12个月(8-17)。16例使用VARIAN Novalis, 4例使用VARIAN Clinac iX, 1例使用VARIAN TrueBeam STx。单次和总辐射剂量分别测定。治疗后所有患者均无视力障碍。垂体功能减退也未见明显恶化。低分割立体定向放射手术允许将高剂量的辐射带到垂体腺瘤,最大限度地减少对视觉通路,垂体和垂体的损害。按照这个顺序,它减少了这项技术的毒性。现代放射技术的应用最大限度地减少了对周围健康组织的照射,减少了治疗的负面影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Radiosurgical treatment of residual and recurrent pituitary adenomas
Objective ‒ the treatment result estimation of subtotally removed and recurrent pituitary adenomas using different algorithms of radiotherapy and radiosurgery.Materials and methods. The retrospective analysis of 21 cases of pituitary adenomas was performed. There were 11 women and 10 men included. The average age was 45 (from 18 to 72) years. All patients had relapse or residual tumor after incomplete surgical removal. The method of irradiation was chosen by a radiologist. Tumor size control was assessed by an independent radiologist in 3 months and 1 year after treatment. Endocrine function was estimated by an independent endocrinologist in 3 months and 1 year after treatment.Results. Following transsphenoidal removal ‒ 13 patients (4 were operated twice), 5 after cranial surgery and 3 were operated sequentially transnasally and transcranially. Irradiation of 14 cases of residual tumor was performed no later than 6 months after surgery. The mean term of treatment start of recurrent adenomas was 12 months (8‒17) after surgery. VARIAN Novalis was applied in 16 cases, VARIAN Clinac iX in 4 cases and VARIAN TrueBeam STx was used once. Single and total radiation doses were determined individually. None of patients had visual impairment after treatment. The hypopituitarism deterioration was not noted as well.Conclusions. Hypofractionated stereotactic radiosurgery allows to bring a high dose of radiation to the pituitary adenomas, minimizing damage to the visual pathways, the pituitary gland and infundibulum. As the sequence, it reduces the toxicity of the technique. The application of modern radiation technologies minimize the irradiation of healthy surrounding tissues and reduce the negative effects of treatment.
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