Abstract：
OBJECTIVE: To explore the potential role of focused radiotherapy in managing the lymphocytic hypophysitis (LH) refractory to medical therapy and surgery.
METHODS: A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution.
RESULTS: The study included eight patients, three from our institution and five from existing literature. The age at presentation ranged from 37 to 75 years old, with a median age of 58. The presenting symptoms involved headache in seven patients and diplopia in two patients. Pre-radiation visual field defects were noticed in four patients. All patients exhibited variable degrees of hypopituitarism before radiation, with oral corticosteroids being the initial medical treatment. Immunosuppressive therapy was attempted in two patients prior to radiation. Seven patients had a history of transsphenoidal surgery with a histologically confirmed LH. Three patients underwent stereotactic radiosurgery (SRS), while the remaining received FSRT, with a mean irradiation volume of 2.2 cm3. A single-session total dose of 12 -15 Gy was administered in the SRS group. In the FSRT group, doses ranged from 24 to 30 Gy with a median dose of 25 Gy, delivered in 2 Gy fractions. Four patients achieved a resolution of visual field defects, while another two patients demonstrated improvement in their associated focal neurologic deficits. No change in pre-existing endocrine status was shown after radiation, except in one patient. Clinical response was achieved in seven patients after a single course of radiation, while one patient required the second course. Six patients remained stable on low-dose glucocorticoid during at least a 12-month follow-up period, and one discontinued it entirely without experiencing relapse. Three patients demonstrated a complete radiologic response, while the remaining showed a partial radiologic response.
CONCLUSIONS: Focused radiation, including FSRT, can play a role in symptomatic relief, effective mass shrinkage, and minimizing radiation exposure to critical surrounding structures in patients with refractory LH. However, further research efforts are necessary to better clarify its effects and optimal dose planning.
METHODS: A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution.
RESULTS: The study included eight patients, three from our institution and five from existing literature. The age at presentation ranged from 37 to 75 years old, with a median age of 58. The presenting symptoms involved headache in seven patients and diplopia in two patients. Pre-radiation visual field defects were noticed in four patients. All patients exhibited variable degrees of hypopituitarism before radiation, with oral corticosteroids being the initial medical treatment. Immunosuppressive therapy was attempted in two patients prior to radiation. Seven patients had a history of transsphenoidal surgery with a histologically confirmed LH. Three patients underwent stereotactic radiosurgery (SRS), while the remaining received FSRT, with a mean irradiation volume of 2.2 cm3. A single-session total dose of 12 -15 Gy was administered in the SRS group. In the FSRT group, doses ranged from 24 to 30 Gy with a median dose of 25 Gy, delivered in 2 Gy fractions. Four patients achieved a resolution of visual field defects, while another two patients demonstrated improvement in their associated focal neurologic deficits. No change in pre-existing endocrine status was shown after radiation, except in one patient. Clinical response was achieved in seven patients after a single course of radiation, while one patient required the second course. Six patients remained stable on low-dose glucocorticoid during at least a 12-month follow-up period, and one discontinued it entirely without experiencing relapse. Three patients demonstrated a complete radiologic response, while the remaining showed a partial radiologic response.
CONCLUSIONS: Focused radiation, including FSRT, can play a role in symptomatic relief, effective mass shrinkage, and minimizing radiation exposure to critical surrounding structures in patients with refractory LH. However, further research efforts are necessary to better clarify its effects and optimal dose planning.
摘要：
目的：探讨聚焦放疗在治疗药物治疗和手术难治性淋巴细胞性垂体炎（LH）中的潜在作用。
方法：根据PRISMA指南进行了系统的文献综述，以确定对垂体炎的放射治疗的研究。以及我们机构的经验。
结果：该研究包括8名患者，三个来自我们的机构，五个来自现有文献。演讲年龄从37岁到75岁不等，平均年龄为58岁。出现的症状包括7例患者的头痛和2例患者的复视。在四名患者中发现了放射前视野缺损。所有患者在放射前都表现出不同程度的垂体功能减退症，口服皮质类固醇是最初的药物治疗。在放疗前对两名患者进行了免疫抑制治疗。7例患者有经蝶窦手术史，经组织学证实为LH。三名患者接受了立体定向放射外科（SRS），而其余的收到FSRT，平均辐照体积为2.2cm3。在SRS组中施用12-15Gy的单次总剂量。在FSRT组中，剂量范围为24至30Gy，中位剂量为25Gy，以2Gy分数交付。四名患者获得了视野缺陷的分辨率，而另外两名患者则表现出相关的局灶性神经功能缺损的改善。放射后未显示先前存在的内分泌状态的变化，除了一个病人。在单疗程放疗后，七名患者获得了临床反应，而一名患者需要第二疗程。6例患者在至少12个月的随访期内，低剂量糖皮质激素保持稳定，一个人完全停止了它，没有复发。三名患者表现出完全的放射学反应，其余显示部分放射学反应。
结论：聚焦辐射，包括FSRT,可以起到缓解症状的作用，有效质量收缩,并尽量减少对难治性LH患者关键周围结构的辐射暴露。然而,需要进一步的研究努力，以更好地阐明其效果和最佳剂量计划。
方法：根据PRISMA指南进行了系统的文献综述，以确定对垂体炎的放射治疗的研究。以及我们机构的经验。
结果：该研究包括8名患者，三个来自我们的机构，五个来自现有文献。演讲年龄从37岁到75岁不等，平均年龄为58岁。出现的症状包括7例患者的头痛和2例患者的复视。在四名患者中发现了放射前视野缺损。所有患者在放射前都表现出不同程度的垂体功能减退症，口服皮质类固醇是最初的药物治疗。在放疗前对两名患者进行了免疫抑制治疗。7例患者有经蝶窦手术史，经组织学证实为LH。三名患者接受了立体定向放射外科（SRS），而其余的收到FSRT，平均辐照体积为2.2cm3。在SRS组中施用12-15Gy的单次总剂量。在FSRT组中，剂量范围为24至30Gy，中位剂量为25Gy，以2Gy分数交付。四名患者获得了视野缺陷的分辨率，而另外两名患者则表现出相关的局灶性神经功能缺损的改善。放射后未显示先前存在的内分泌状态的变化，除了一个病人。在单疗程放疗后，七名患者获得了临床反应，而一名患者需要第二疗程。6例患者在至少12个月的随访期内，低剂量糖皮质激素保持稳定，一个人完全停止了它，没有复发。三名患者表现出完全的放射学反应，其余显示部分放射学反应。
结论：聚焦辐射，包括FSRT,可以起到缓解症状的作用，有效质量收缩,并尽量减少对难治性LH患者关键周围结构的辐射暴露。然而,需要进一步的研究努力，以更好地阐明其效果和最佳剂量计划。
