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目的分析伽玛刀(GK)治疗泌乳素腺瘤后长期随访结果,探讨伽玛刀治疗泌乳素腺瘤的有效性和安全性。方法本组治疗泌乳素腺瘤病人67例,所有病人均采用旋转式伽玛刀、-γTPS规划系统治疗。56例(87.5%)等剂量曲线为50%,周边剂量20~35Gy(中位24.4Gy)。治疗后随访9~96个月,3例失随访,分别观察病人PRL水平、肿瘤影像学变化及垂体功能低下、视力视野变化、肿瘤周围颅神经等并发症出现情况。结果GK治疗后血PRL有降低者为89.1%(57/64),血PRL达到正常水平者28例(43.8%),激素正常化平均时间为20.3个月(9~58个月)。多变量分析中,较高的周边剂量(T=0.001)和中心剂量(T=0.005)与激素正常化具有显著相关性。肿瘤生长控制率为96.9%(62/64),肿瘤缩小率为48.4%(31/64)。未见视力、视野损害及周围颅神经损伤病例。7例病人出现垂体功能低下。结论GK治疗PRL腺瘤是安全而有效的,选择适宜的周边剂量可以良好的控制肿瘤生长和内分泌水平,应强调视通路、周围颅神经的保护,治疗后需加强定期随访。
Objective To analyze the long-term follow-up results of gamma knife (GK) in the treatment of prolactinoma, and to explore the efficacy and safety of gamma knife in the treatment of prolactinoma. Methods In this group, 67 patients with prolactinoma were treated. All patients were treated with rotary gamma knife and -γTPS planning system. The isodose curve of 56 patients (87.5%) was 50%, and the peripheral dose was 20 to 35 Gy (median 24.4 Gy). After treatment, the patients were followed up for 9 to 96 months. Three patients lost follow-up. The complications such as PRL level, tumor imaging changes, hypopituitarism, visual field changes, and cranial nerve around the tumor were observed. Results The blood PRL was reduced by 89.1% (57/64) after GK treatment, and 28 cases (43.8%) by normal blood PRL level. The average time of hormone normalization was 20.3 months (9~58 months). In the multivariate analysis, higher peripheral doses (T = 0.001) and central dose (T = 0.005) were significantly associated with hormone normalization. The tumor growth control rate was 96.9% (62/64) and the tumor reduction rate was 48.4% (31/64). No vision, visual field damage, and cases of peripheral cranial nerve injury were observed. Seven patients showed hypopituitarism. Conclusions GK is safe and effective in the treatment of PRL adenomas. Choosing the right peripheral dose can control tumor growth and endocrine levels well. It should emphasize the protection of visual pathways and surrounding cranial nerves, and regular follow-ups are needed after treatment.