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首页> 外文期刊>Neurosurgery >Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas.
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Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas.

机译：重新评估放射疗法在治疗内分泌失活性垂体大腺瘤中的作用。

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OBJECTIVE: This prospective clinical trial was undertaken to assess the rate of tumor recurrence in patients with endocrine-inactive pituitary macroadenomas who underwent gross total surgical resection of their tumors and did not receive adjuvant radiotherapy. METHODS: Between December 1987 and July 1994, 45 patients with endocrine-inactive pituitary macroadenomas underwent transsphenoidal surgery. In 38 (84%) of these patients, gross total surgical resection was achieved and was confirmed by postoperative magnetic resonance imaging (n = 37) or computed tomography (n = 1). After receiving counseling from the neurosurgeon concerning the risks and benefits of radiation therapy, 32 of the 38 patients elected not to receive adjuvant radiotherapy. Patients were followed through March 1998 with radiographic imaging obtained every 6 months for the first 2 years, annually for postoperative Years 3 and 4, and then every 2 to 3 years thereafter. The study end point was defined as radiographic tumor recurrence or patient death. RESULTS: The mean follow-up duration for the study group was 5.5 years. During that time, 2 of 32 (6%) patients developed recurrence, at 18 and 24 months, respectively, after initial surgery. Both were successfully treated using radiation therapy, with one requiring additional surgery. Three additional patients died as a result of unrelated causes 9, 12, and 49 months, respectively, after initial surgery. Immunocytochemical analysis revealed 66% of the tumors to be weak gonadotroph cell adenomas, 22% to be null cell adenomas, 9% to be silent prolactinomas, and 3% to be silent corticotroph cell adenomas. CONCLUSION: This study demonstrates a 6% 5-year recurrence rate in patients with endocrine-inactive pituitary macroadenomas treated using gross total surgical resection alone. Reserving radiation therapy for the infrequent patient with recurrence and sparing the majority of patients the associated risks inherent in its use seems reasonable.
机译：目的：进行这项前瞻性临床试验，以评估接受内分泌非活动性垂体大腺瘤的患者，这些患者接受了肿瘤的整体外科手术切除并且未接受辅助放疗。方法：1987年12月至1994年7月，对45例内分泌失活的垂体大腺瘤患者进行了蝶窦手术。在这些患者中的38名（84％）中，已实现了总的手术切除，并通过术后磁共振成像（n = 37）或计算机断层扫描（n = 1）得以证实。在接受了神经外科医师关于放疗风险和益处的咨询后，在38位患者中，有32位选择不接受辅助放疗。随访患者直至1998年3月，头2年每6个月进行一次射线照相成像，术后3年和4年每年进行一次射线照相，其后每2至3年进行射线照相。研究终点定义为影像学复发或患者死亡。结果：研究组的平均随访时间为5。5年。在此期间，最初手术后的18个月和24个月分别有32例患者中的2例（6％）复发。两者均通过放射疗法成功治疗，其中一项需要额外的手术。初次手术后分别有9、12和49个月的不相关原因导致另外三名患者死亡。免疫细胞化学分析显示，66％的肿瘤为弱性腺营养腺细胞腺瘤，22％为空细胞腺瘤，9％为沉默泌乳素瘤，3％为沉默皮质激素营养腺瘤。结论：这项研究表明，仅用总外科切除术治疗的内分泌失活性垂体大腺瘤患者的5年复发率为6％。为少见的复发患者保留放射疗法，并为大多数患者保留使用放射疗法固有的相关风险似乎是合理的。

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