目标:伽玛刀放射外科(GKRS),通常在单个会话(S-GKRS)中进行管理,是无功能垂体腺瘤(NFPA)的有效治疗方法。对于靠近视路的病变,大分割放射外科的使用越来越多。这项研究旨在比较与视路相邻的NFPA的S-GKRS与分馏GKRS(F-GKRS)的结果。
方法:本研究回顾性纳入两组接触视路的残留或复发NFPA患者:(1)一组在欧洲接受3天的F-GKRS治疗的患者,以及(2)一组在美国接受S-GKRS治疗的患者。进行倾向评分匹配(比率1:1)以获得并比较2个同质的NFPA患者组。
结果:共纳入84例患者进行分析(42例在S-GKRS组,42例在F-GKRS组)。这两个队列的年龄没有差异,性别,以前的外科手术数量,肿瘤体积,和后续行动。F-GKRS和S-GKRS组的平均随访时间为60.2±37.0个月和62.4±37.4个月。分别(P=0.38)。在F-GKRS和S-GKRS中,有95.2%和92.9%的患者在末次随访时实现了总体肿瘤控制。分别(P=.64)。1年,3年,5年,F-GKRS术后7年无进展生存率为100%,97.1%,97.1%,91%,分别。在S-GKRS样本中,无进展生存率为100%,100%,92.5%,治疗后1年、3年、5年和7年为92.5%,分别。来自F-GKRS队列的2例患者(4.7%)和来自S-GKRS队列的2例患者(4.7%)在放射外科手术后持续视力恶化(P=1.0)。
结论:在与视路相邻的NFPA的管理中,F-GKRS和S-GKRS在7年时具有相当的结果和风险。需要未来的前瞻性研究,包括更大的队列和更长的随访,以证实我们的结果。
OBJECTIVE: Gamma Knife radiosurgery (GKRS), typically administered in a single session (S-GKRS), is an effective treatment for nonfunctioning pituitary adenoma (NFPA). For lesions close to the optic pathway, the use of hypofractionated radiosurgery is growing. This
study seeks to compare the results of S-GKRS vs fractionated-GKRS (F-GKRS) for NFPAs adjacent to the optic pathway.
METHODS: Two cohorts of patients with residual or recurrent NFPAs in contact to the optic pathway were retrospectively included in this
study: (1) a group of patients who underwent a 3-day course of F-GKRS in Europe and (2) a group of patients treated with S-GKRS in the United States. A propensity score matching (ratio 1:1) was carried out to obtain and compare 2 homogeneous groups of patients with NFPA.
RESULTS: A total of 84 patients were included for analysis (42 in the S-GKRS cohort and 42 in the F-GKRS group). The 2 cohorts did not differ for age, sex, number of previous surgical procedure, tumor volume, and follow-up. The mean follow-up was 60.2 ± 37.0 months and 62.4 ± 37.4 months for F-GKRS and S-GKRS cohort, respectively ( P = .38). The overall tumor control at last follow-up was achieved in 95.2% and 92.9% of patients in F-GKRS and S-GKRS, respectively ( P = .64). The 1-year, 3-year, 5-year, and 7-year progression-free survival rate after F-GKRS was 100%, 97.1%, 97.1%, and 91%, respectively. In the S-GKRS sample, progression-free survival rates were 100%, 100%, 92.5%, and 92.5% at 1, 3, 5, and 7 years after treatment, respectively. Two patients (4.7%) from the F-GKRS cohort and 2 (4.7%) from the S-GKRS cohort sustained visual worsening after radiosurgery ( P = 1.0).
CONCLUSIONS: In the management of NFPAs adjacent to the optic pathway both F-GKRS and S-GKRS had comparable outcomes and risks at 7 years. Future prospective studies including larger cohorts with longer follow-up are needed to confirm our results.