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Clinical and Translational Oncology

, Volume 7, Issue 10, pp 447–454 | Cite as

Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos

  • Rosa M Cañón Rodríguez
  • David Ortiz de Urbina
  • Juan Carlos Viera
  • César Beltrán
  • Fernando Puebla
  • M Isabel García Berrocal
  • Ana Mañas
  • Carmen Peraza
  • Felipe A. Calvo
Original Articles
  • 54 Downloads

Resumen

Introducción

Se analizan retrospectivamente la supervivencia global (SG), control local, factores pronóstico y toxicidad, de pacientes con adenoma de hipófisis tratados con radioterapia estereotáxica fraccionada (REF).

Material y métodos

Entre mayo de 1994 y junio de 2001 se trataron 56 pacientes con adenomas de hipófisis, 23 (41,1%) primarios y 33 recidivas. Veinticuatro (42,9%) casos fueron adenomas no funcionantes, y 32 (57,1%) funcionantes. La mediana de dosis administrada fue 54 Gy (rango 24–56 Gy), 2 Gy/día, 5 días/semana.

Resultados

Con un seguimiento de 51 meses (9–102 meses), al cierre del estudio, 49 pacientes están vivos sin evidencia de enfermedad, una paciente viva, con pérdida de visión y progresión hormonal, 2 pacientes han fallecido con progresión y uno falleció por otra causa. La supervivencia global fue de 94% (50/53), con una supervivencia libre de fallo del 92% (49/53). En análisis univariado sólo el tipo de hormona secretada (ACTH) y la irradiación previa resultaron de mal pronóstico. Catorce pacientes (25%) presentaron síntomas leves de toxicidad aguda durante la radioterapia estereotáxica fraccionada y 3 (5,4%) desarrollaron toxicidad tardía, neuropatía óptica (2 pacientes, multipatología asociada) y radionecrosis (1 paciente, reirradiación).

Conclusiones

La radioterapia estereotáxica fraccionada es eficaz para adenomas de hipófisis, aunque es preciso valorar individualmente a aquellos pacientes con patologías concomitantes, o con tratamientos de radioterapia previa, con objeto de minimizar la aparición de efectos adversos a largo plazo.

Palabras clave

radioterapia estereotáxica fraccionada adenoma de hipófisis factores pronósticos toxicidad tardía 

Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas

Abstract

Aims

To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT).

Material and methods

Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24–56 Gy).

Results

The median follow-up was 51 months (range: 9–102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation).

Conclusion

Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects.

Key words

fractionated stereotactic radiotherapy pituitary adenomas prognostic factors late-onset toxicity 

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Bibliografía

  1. 1.
    Grigsby PW. Pituitary. En: Pérez CA, Brady LW, editors. Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia: Lippincott-Raven; 1997. p. 829–48.Google Scholar
  2. 2.
    Francine E, Halberg MD. Pituitary tumors. En: Gunderson LI, Tepper J, editors. Clinical Radiation Oncology, Section III, Philadelphia: Churchill-Livingstone; 2000. p. 378–95.Google Scholar
  3. 3.
    Levin VA, Gutin PH, Leibel S. Neoplasms of the central nervous system. En: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 4th. ed. Philadelphia: Lippincont Company; 1993. p. 1696–724.Google Scholar
  4. 4.
    Buatti J, Marcus R. Pituitary adenomas: current methods of diagnosis and treatment. Oncology (Huntingt). 1997; 11:791–6.Google Scholar
  5. 5.
    Grigsby PW. Pituitary adenoma. En: Meyer JL, editor. The radiation therapy of benign Diseases. Current indications and techniques. Front Radiat Ther Oncol. Basel: Karger; 2001: p. 48–56.CrossRefGoogle Scholar
  6. 6.
    Milker-Zabel S, Debus J, Thilmann C, Schlegel, W, Wannenmacher M. Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland. Int J Radiat Oncol Biol Phys. 2001;50:1279–86.PubMedCrossRefGoogle Scholar
  7. 7.
    Shrieve DC, Kooy HM, Tarbell NJ, Loeffler JS. Fractionated stereotactic radiotherapy. Important Adv Oncol. 1996; 205–24.Google Scholar
  8. 8.
    Ortiz de Urbina D, Santos M, Samblás J, et al. Tratamiento con radiocirugía estereotáxica del glioma cerebral primario de alto grado. Neurocirugía. 1999;10:350–8.Google Scholar
  9. 9.
    Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.PubMedGoogle Scholar
  10. 10.
    Trotti A, Byhardt R, Stetz J, et al. Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47:13–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRefGoogle Scholar
  12. 12.
    Brada M, Rajan B, Traish D, et al. The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf). 1993;38:571–8.Google Scholar
  13. 13.
    Becker G, Kocher M, Kortmann RD, et al. Radiation Therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol. 2002;178:173–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Grigsby PW, Simpson JR, Bahman NE, et al. Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1989;16:1411–7.PubMedGoogle Scholar
  15. 15.
    Tran LM, Blount L, Horton D, et al. Radiation therapy of pituitary tumors: results in 95 cases. Am J Clin Oncol. 1991;14:25–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Tsang RW, Brierley JD, Panzarella T, et al. Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 1994;30:557–65.PubMedGoogle Scholar
  17. 17.
    Zierhut D, Flebtje M, Adolph A, et al. External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1995;33:307–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Grigsby PW, Stokes S, Marks JE, et al. Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1988; 15:1103–10.PubMedGoogle Scholar
  19. 19.
    Urdaneta N, Chessin H, Fischer JJ. Pituitary adenomas and craniopharyngiomas: Analysis of 99 cases treated with radiation therapy. Int J Radiat Oncol Biol Phys. 1976; 1:895–902.PubMedGoogle Scholar
  20. 20.
    Flickinger JC, Nelson PB, Martínez AJ, et al. Radiotherapy of nonfunctional adenomas of the pituitary gland: Results with long-term follow-up. Cancer. 1989;63:2409–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Sasaki R, Murakami M, Okamoto Y, et al. The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys. 2000;47: 1337–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Kalapurakal JA, Silverman CL, Akhtar N, et al. Acute hyperthermia following stereotactic radiosurgery for pituitary adenoma. Br J Radiol. 1999;72:1218–21.PubMedGoogle Scholar
  23. 23.
    Brada M, Burchell L, Ashley S, Traish D. The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys. 1999;45:693–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Movsas B, Movsas TZ, Steinberg S, Okunieff P. Long-term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys. 1995;33:599–605.PubMedCrossRefGoogle Scholar
  25. 25.
    Murphy CB, Hashimoto SA, Graeb D, Thiessen BA. Clinical exacerbation of multiple sclerosis following radiotherapy. Arch Neurol. 2003;60:273–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Milker-Zabel S, Zabel A, Huber P, Schlegel W, Wannenmacher M, Debus J. Stereotactical conformal radiotherapy in patients with growth hormone-secreting pituitary adenoma. Int J Radiat Oncol Biol Phys. 2004;59:1088–96.PubMedCrossRefGoogle Scholar
  27. 27.
    Pickett CA. Diagnosis and management of pituitary tumors: recent advances. Prim Care Clin Office Pract. 2003 (30):765–89.CrossRefGoogle Scholar
  28. 28.
    Estrada J, Boronat M, Mielgo M, et al. The long-term outcome of pituitary irradiation after unsuccessful transphenoidal surgery in Cushing's disease. N Engl J Med. 1997;336:172–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Paek SH, Downes MB, Bednarz G, et al. Integration of surgery with fractionated stereotactic radiotherapy for treatment of nonfunctioning pituitary macroadenomas. Int J Radiat Oncol Biol Phys. 2005;61:795–808.PubMedCrossRefGoogle Scholar
  30. 30.
    Hoybye C, Grenback E, Rahn T, Degerblad M, Thoren M, Hulting AL. Adrenocorticotropic hormone-producing pituitary tumors: 12-to-22- year follow-up after treatment with stereotactic radiosurgery. Neurosurgery. 2001;49:284–91.PubMedCrossRefGoogle Scholar

Copyright information

© FESEO 2005

Authors and Affiliations

  • Rosa M Cañón Rodríguez
    • 1
  • David Ortiz de Urbina
    • 1
  • Juan Carlos Viera
    • 1
  • César Beltrán
    • 1
  • Fernando Puebla
    • 1
  • M Isabel García Berrocal
    • 2
  • Ana Mañas
    • 3
  • Carmen Peraza
    • 1
  • Felipe A. Calvo
    • 4
  1. 1.Unidad de Oncología-Radioterapia-RadiocirugíaHospital San Francisco de AsísMadridEspaña
  2. 2.Hospital Puerta de HierroMadridEspaña
  3. 3.Hospital 12 de OctubreMadridEspaña
  4. 4.Hospital General Universitario Gregorio MarañónMadridEspaña

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