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- Title
Intensity-modulated Radiotherapy for Pituitary Somatotroph Adenomas.
- Authors
Xin Lian; Jing Shen; Zhaoqi Gu; Junfang Yan; Shuai Sun; Xiaorong Hou; Hui You; Bing Xing; Huijuan Zhu; Jie Shen; Fuquan Zhang; Lian, Xin; Shen, Jing; Gu, Zhaoqi; Yan, Junfang; Sun, Shuai; Hou, Xiaorong; You, Hui; Xing, Bing; Zhu, Huijuan
- Abstract
<bold>Objective: </bold>To summarize our experience in the treatment of pituitary somatotroph adenomas by fractionated intensity-modulated radiotherapy (IMRT), describe the treatment outcomes, and determine predictors.<bold>Methods and Materials: </bold>Patients with pituitary somatotroph adenoma treated by IMRT in our institution from August 2009 to January 2019 were reviewed. A total of 113 patients (37 male) were included in this study. The median age was 33 years (range 12-67 years). A total of 112 patients had not achieved complete remission after surgery, and 1 patient was treated by radiotherapy (RT) alone because she refused to surgery. The median growth hormone level was 8.6 ng/mL (range 2-186 ng/mL) and the median insulin-like growth factor (IGF)-1 level was 732 ng/mL (range 314-1485 ng/mL) pre-RT. The radiation doses to clinical target volume were usually 50-56 Gy in 25 to 30 fractions and to gross tumor volume were 60.2 Gy in 28 fractions while simultaneous integrated boost-IMRT used. After RT, the patients were followed up with endocrine testing every 6 to 12 months and magnetic resonance imaging annually. Endocrine complete remission was defined as a normal sex- and age-adjusted IGF-1 level without any pituitary suppressive medications. The outcomes including endocrine remission and new hypopituitarism after RT were recorded. The median follow-up time was 36 months (range 6-105.5 months).<bold>Results: </bold>The endocrine complete remission rates of IGF-1 at 1, 2, 3, and 5 years were 6%, 22.8%, 48.6%, and 74.3%, respectively. The median time to complete remission was 36.2 ± 3.8 months. The tumor control rate was 99% during the follow-up. The overall incidence of RT-induced hypopituitarism was 28.3% at the last follow-up. Univariate and multivariate analysis demonstrated that tumor sizes before RT, pre-RT IGF-1 level, and age significant predicted the endocrine remission.<bold>Conclusions: </bold>IMRT is a highly effective treatment for pituitary somatotroph adenoma. Endocrine remission rate, tumor control rate, the median time to remission and hypopituitarism incidence are similar to stereotactic radiosurgery. Age and IGF-1 level before RT were significant predictive factors in endocrine remission.
- Subjects
INTENSITY modulated radiotherapy; PITUITARY dwarfism; PITUITARY gland; CONTRAST-enhanced magnetic resonance imaging; CHILD patients; RADIOSURGERY; ADENOMA; RETROSPECTIVE studies; PROGNOSIS; GROWTH hormone-secreting pituitary adenoma; TREATMENT effectiveness; RADIOTHERAPY
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 12, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa651