Radioterapia estereotáxica fraccionada en adenomas de hipófisis: resultados y factores pronósticos / Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas

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

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