腦垂體腺瘤之放射線治療

目的：腦垂體腺瘤的治療有三種基本方法，合併使用手術和放射治療常用於治療較大的腺瘤及腫瘤復發之救援。本文的目的在探討合併使用手術和放射治療的存活率，以及各種預後因子對存活率之影響。材料與方法︰自1983至1993 年間，總計47位經病理報告證實為腦垂體腺瘤的患者在馬偕紀念醫院接受放射線治療。其中共有25位男性及22位女性，年齡範圍由21至71歲（中值為42.5歲）。最常見的症狀為視力障礙(佔72%)和頭痛(佔60%)。放射線是經由6MV 光子或鈷60射線，每周照射5次，每次給予180至200 cGy(中值為5800 cGy)，全部追蹤時間由2至11年（中值為5.6年）。結果：47位病人分成(A)及(B)兩組。(A)組有42位患者是接受非根除性手術後加上放射線治療，其中有4位中途失去追蹤、3位復發及5位死亡。死亡的原因有4位是因腫瘤壓迫，另1位為腦血管梗塞。手術後放射治療之5年整體存活率為87%，無復發存活率為93%。(B)組有5位病人以放射線治療來處理手術後復發之腫瘤。其中的1位在124個月後因腫瘤壓迫致死，其餘4位情況正常。結論：利用log-rank test 來分析預後因子，發現年齡、性別及劑量對存活率影響之差異皆不具有統計學上意義。但整體而言，對於較大的腦垂體腺瘤，我們發現手術後加上放射線治療可得到不錯的腫瘤控制率,也許可以取代根除手術成為較大的腦垂體腺瘤之標準治療方法。

關鍵字

腦部腫瘤；腦垂體腺瘤；放射治療學

並列摘要

Aims: Patients with pituitary adenoma can be managed by three effective modes of treatments. Combined surgery and radiotherapy were used to treat pituitary macroadenoma and recurrent pituitary adenoma. The object of this study was to investigate the survival rate and prognostic factors using combined surgery and radiotherapy. Materials and Methods: Between 1983 and 1993, 47 patients with pathologically proven pitiuitary adenoma received radiation therapy at Mackay Memorial Hospital. Of these patients, 25 were males and 22 were females. The median age was 42.5 years with a range of 21 to 71 years. Visual disturbance (72%) and headache (60%) were the most common symptoms. Irradiation was delivered with 6-MV photon or Co-60 gamma ray, 5 days per week, at a dose of 180 to 200 cGy per fraction. The total tumor dose ranged from 4140 cGy to 6500 cGy with a median dose of 5800 cGy. The follow-up period ranged from 2 to 11 years with a median time of 5.6 years. Results: 47 patients were divided into two groups by their tumor status before radiation therapy. Group A patients, consisting of 42 patients were underwent incomplete resection and radiation therapy as the primary treatment. Among these patients, 4 patients were lost during follow-up, and 3 patients experienced recurrence of the tumor. Five patients died during the follow-up period, 4 patients for uncontrolled disease and one patient for CVA. The overall 5-year survival rate was 87% and the relapse-free survival rate was 93%. Group (B) patients, cansisting of 5 patients were treated for recurrence after surgery. Of these patients, one died due to tumor compression 124 months after radiotherapy, but the remaining 4 cases are still doing well. Conclusions: Using the Log-rank test, gender, age and dose are not significant prognostic factors. In brief, we found that appropriate surgery and postoperative radiation therapy could achieve good local control and may replace radical surgery as the standard treatment for pituitary macroadenoma.

並列關鍵字

Brain neoplasm ； Pituitary adenoma ； Radiation therapy

國際替代計量

腦垂體腺瘤之放射線治療

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