20-Year MRI and CT Scan Follow-up of Pituitary Adenomas: Tumor Regression and the Implications for Radiotherapy
Tóm tắt
Purpose/Objective: Pituitary adenomas are benign endocrine tumors that represent 10% of all intracranial neoplasms. These tumors have a variable growth rate and a variable response to hormonal manipulation, radiotherapy, or surgery. Surprisingly, very little information is available documenting regression of pituitary adenomas after surgery with serial imaging studies. To clearly define the postoperative regression rate of pituitary adenomas, we analyzed a group of 35 patients who had undergone surgery and pre- and postoperative imaging over a 20-year period. Materials and Methods: Between 1977 and 1997, 125 patients with pituitary macroadenomas were managed at our institution. Fourteen patients were observed without surgery or radiation. Follow-up MR and CT data were available for 73 patients; 38 patients received postoperative radiation; 38 patients were without adequate follow-up. The remaining 35 patients who underwent trans-sphenoidal hypophysectomy (TSH) alone comprise the cohort for analysis. To follow the changes in tumor size with time, individual measurements were obtained on all patients from CT and MR using standard response criteria, namely, the product of the two maximal orthogonal dimensions. Results: The mean follow-up period for all patients was 24.4 months. The age at diagnosis for all patients ranged from 20 to 78 years (mean 46.4 years). The mean initial and postoperative tumor maximal cross-sectional areas were 5.4 cm2 and 3.6 cm2, respectively. The mean time period to achieve a mean maximal decrease in postoperative tumor size of 2.9 cm2 was 3 months. Subsequently, at 6, 12, and 24 months, there was a 4%, 17%, and 21% respective increase in tumor size. Conclusion: Serial MRIs and CTs document that a significant decrease in tumor size is possible after TSH for pituitary macroadenomas. There appears, however, to be no benefit in observing patients beyond 3 months postoperatively as this is the nadir of tumor regression. Furthermore, tumor size appears to increase on 2-year follow-up. Since maximal tumor shrinkage is desired prior to XRT to reduce the RT dose received by the optic apparatus and normal brain tissues, these data may aid in determining when to administer postoperative radiation. Additional follow-up data on the value of observation and/or postoperative radiation may add to the current knowledge that is available on the natural history of treated or untreated pituitary macroadenomas.
Tài liệu tham khảo
Burrow GN, Wortzman G, Rewcastle NB, et al.: Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Eng J Med 304:156–158, 1981
Leavens ME, McCutcheon IF, Samaan NA: Management of pituitary adenomas. Oncology 6:69–79, 1992
McCutcheon IE: Pituitary tumors. In Cancer in the Nervous System. pp. 219–239
Kovacs K, Horvath E: Tumors of the Pituitary Gland. Washington, DC: Armed Forces Institute of Pathology, 1986
Ebersold MJ, Quast LM, Laws ER, Scheithauer B, Randall RV: Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 64:713–719, 1986
Halberg FE, Sheline GE: Radiotherapy of pituitary tumors. Endocrinol Metab Clin 16:667–684, 1987
Ciric I, Mikhael M, Stafford T, Lawson L, Garces R: Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 59:395–401, 1983
Chun M, Masko G, Hatelekidis S: Radiotherapy in the treatment of pituitary adenomas. Int J Radiat Oncol Biol Phys 1:895–902, 1976
Parsons JT, Fitzgerald CR, Hood CI, Ellingwood KE, Bova FJ, Million RR: The effects of irradiation on the eye and optic nerve. Int J Radiat Oncol Biol Phys 9:609–622, 1983
McCullough WM, Marcus RB, Rhoton AL, Ballinger WE, Million RR: Long-term follow-up of radiotherapy for pituitary adenoma: The absence of late recurrence after >4500 cGy
Movsas B, Movsas TZ, Steinberg SM, Okunieff P: Long-term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys 33:599–605, 1995
Grigsby PW, Stokes S, Marks JE, Simpson JR: Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 15:1103–1110, 1988
Grigsby PW, Simpson JR, Emami BB, Fibeberg BB, Schwartz HG: Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 16:1411–1417, 1989
Grigsby PW: Pituitary adenomas: Evolving diagnosis and management. Int J Radiat Oncol Biol Phys 27:1253–1254, 1993
Hughes MN, Llamas KJ, Yelland ME, Obst D, Tripcony LB: Pituitary adenomas: Long-term results for radiotherapy alone and post-operative radiotherapy. Int J Radiat Oncol Biol Phys 27:1035–1044, 1993
Laws ER, Fode NC, Redmond MJ: Transsphenoidal surgery following unsuccessful prior therapy: An assessment of benefits and risk in 158 patients. J Neurosurg 63:823–829, 1985
Dowsett RJ, Fowble B, Sergott RC, Savino PJ, Bosley TM, Snyder PJ, Gennarelli TA: Results of radiotherapy in the treatment of acromegaly: Lack of ophthalmologic complications. Int J Radiat Oncol Biol Phys 19:453–549, 1990
Koppelman MCS, Jaffe MJ, Rieth KG, Caruso RC, Loriaux DL: Hyperprolactinemia, amenorrhea and galactorrhea: A retrospective analysis of twenty-five cases. Ann Intern Med 100:115–121, 1984
Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M: External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys 33:307–314, 1995
Gonzalez ER: To treat or not to treat: Hyperprolactinemia. JAMA 248:515–516, 1982
Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A: The natural history of untreated hyperprolactinemia: A prospective analysis. J Clin Endocrinol Metab 68:412–418, 1989
Rush SC, Newall J: Pituitary adenoma: The efficacy of radiotherapy as the sole treatment. Int J Radiat Oncol Biol Phys 17:165–169, 1989
Weiss MH, Teal J, Gott P, Wycoff R, Yadley R, Apuzzo MLJ, Giannotta SL, Kletsky O, March C: Natural history of microprolactinomas: Six-year follow-up. Neurosurgery 12:180–183, 1983
Hemminghytt P, Kalkhoff D, Daniels D, Williams P, Haughton V: Computed tomographic study of hormone-secreting microadenomas. Neuroradiology 146:65–69, 1983
Dietmann JL, Portha C, Cattin F, Mollet E, Bonneville JF: CT follow-up of microprolactinomas during bromocriptine-induced pregnancy. Neuroradiology 25:133–138, 1983
Sisam DA, Sheehan JP, Sheeler LR: The natural history of untreated microprolactinomas. Fertility and Sterility 48:67–71, 1987
March CM, Kletzky OA, Dvajan V, Teal J, Weiss M, Apuzzo MLJ, Marrs RP, Mishell DR: Longitudinal evaluation of patients with untreated prolactin-secreting pituitary adenomas. Am J Obstet Gynecol 139:835–844, 1981
Estrada J, Boronat M, Mielgo M, Magallon R, Millan I, Diez S, Lucas T, Barcelo B: The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease. N Engl J Med 336:172–177, 1997
Corn BW, Yousem DM, Scott CB, Rotman M, Asbell SO, Nelson D, Martin L, Curran WJ: White matter changes are correlated significantly with radiation dose. Cancer 74:2828–2835, 1994
Tsang RW, Laperriere NJ, Simpson WJ, Brierley J, Panzarella T, Smyth HS: Glioma arising after radiation therapy for pituitary adenoma. Cancer 72:2227–2233, 1993
Constine LS, Konski A, Ekholm S, McDonald S, Rubin P: Adverse effects of brain irradiation correlated with MR and CT imaging. Int J Radiat Oncol Biol Phys 15:319–330, 1988
Curran WJ, Hecht-Leavitt C, Schut L, Zimmerman RA, Nelson DF: Magnetic resonance imaging of cranial radiation lesions. Int J Radiat Oncol Biol Phys 13:1093–1098, 1987
Al-Mefty O, Kersh JE, Routh A, Smith RR: The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 73:502–512, 1990
Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D: Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma. BMJ 304: 1343–1345, 1992
Jones A: Radiation oncogenesis in relation to the treatment of pituitary tumours. Clin Endocrinol 35:379–397, 1991
Gill SS, Thomas DG, et al.: Relocatable frame for stereotactic external beam radiotherapy. Int J Radiat Oncol Biol Phys 29:599–603, 1991
Tran LM, Blount L, Horton D, Sedeghi A, Parker RG: Radiation therapy of pituitary tumors: Results in 95 cases. Am J Clin Oncol 14:25–29, 1991
Ron E, Modan B, Boice JD, et al.: Tumors of the brain and the central nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039, 1988
Waltz TA, Brownell B: Sarcoma: A possible late result of effective radiation therapy for pituitary adenoma. Report of two cases. J Neurosurg 24:901–907, 1966
Shi T, Farrell MA, Kaufmann JCE: Fibresarcoma complicating irradiated pituitary adenoma. No Shinkei Geka 8:605–614, 1980
Souhami et al.: Fractionated stereotactic radiation therapy for intracranial tumors. Cancer 68:2102–2108, 1991
Dunbar et al.: Stereotactic radiotherapy for pediatric and adult brain tumors: Preliminary report. Int J Radiat Oncol Biol Phys 30:531–539, 1994
Harris JR, Levine MB: Visual complications following irradiation for pituitary adenomas and craniopharyngiomas. Radiology 120:167–171, 1976
Cohen MS, Kushner MJ, Dell S: Frontal lobe astrocytoma following radiotherapy for medulloblastoma. Neurology 31:616–619, 1981
Marus G, Levin CV, Rutherford GS: Malignant glioma following radiotherapy for unrelated primary tumors. Cancer 58:886–894, 1986
Rubenstein AB, Shalit MN, Cohen ML, et al.: Radiation-induced cerebral meningioma: A recognizable entity. J Neurosurg 61:966–971, 1984
Soffer D, Pittaluga S, Feiner M, et al.: Intracranial meningiomas following low-dose irradiation to the head. J Neurosurg 48:622–627, 1978
Devita VT, Hellman S, Rosenberg SA. (eds): Cancer, Principles and Practices of Oncology. J.B. Lippincott Co., 1993