替莫唑胺治疗难治性垂体腺瘤

doi:10.3969/j.issn.1009-976X.2020.04.027

摘要/Abstract

摘要： 目的探讨替莫唑胺在难治性垂体腺瘤中的疗效。方法回顾性分析近年收治的3例难治性垂体腺瘤患者,包括1例侵袭性无功能腺瘤,1例肢端肥大症,1例库欣病,总结其临床过程及应用替莫唑胺治疗后的效果并结合文献进行分析。结果侵袭性无功能腺瘤患者经12个月替莫唑胺治疗,肿瘤明显缩小,随访1年,未见肿瘤进展;肢端肥大症患者经过6个月治疗,随访3月,肿瘤有所缩小,激素水平无明显下降;库欣病患者经过4个月治疗,肿瘤无明显变化,激素水平无下降。结论替莫唑胺在控制难治性垂体腺瘤大小可能有一定作用,但短疗程的治疗对肢端肥大症和库欣病患者的激素水平控制效果不理想,日后仍需继续研究。

关键词: 垂体腺瘤, 难治性, 替莫唑胺

Abstract: Objective To investigate the efficacy of temozolomide in refractory pituitary adenomas. Methods Three patients with non-functional pituitary adenoma or acromegaly, or Cushing's disease was retrospectively reviewed and analyzed with the literature. Results The patient with invasive nonfunctional pituitary adenoma were responded to 12 months of the temozolomide treatment. The tumor size continue to be stable at 1 year follow-up. In the patient with acromegaly, there was a decrease in the tumor size without a concomitant decline in the GH concentration aftersixcyclestreatment. For the patient with Cushing's disease, hypercortisolism remained with the tumor size stable. Conclusion Temozolomide may play a role in controlling the tumors size. However, the short-term treatment could not achievehormonal responsesin patients with acromegaly or Cushing's disease. Further research is needed in the future.

Key words: temozolomide, refractory, pituitary adenoma

中图分类号:

R736.4

冯子泽, 伍益, 李智斌, 董家军, 古机泳, 彭逸龙. 替莫唑胺治疗难治性垂体腺瘤[J]. 岭南现代临床外科, 2020, 20(04): 527-530.

FENG Zi-ze, WU Yi, LI Zhi-bin, DONG Jia-jun, GU Ji-yong, PENG Yi-long.. Temozolomide therapy for refractory pituitary adenomas[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 527-530.

参考文献

[1] 中国垂体瘤协作组,中华医学会神经外科学分会. 中国难治性垂体腺瘤诊治专家共识(2019)[J]. 中华医学杂志, 2019, 99(15):1454-1459.
[2] Lim S, Shahinian H, Maya MM, et al.Temozolomide: a novel treatment for pituitary carcinoma[J]. Lancet Oncol, 2006, 7(6):518-520.
[3] Syro LV, Uribe H, Penagos LC, et al.Antitumour effects of temozolomide in a man with a large, invasive prolactin-producing pituitary neoplasm[J]. Clin Endocrinol,2006,65(4):552-553.
[4] Ezzat S, Asa SL, Couldwell WT, et al.The prevalence of pituitary adenomas: a systematic review[J]. Cancer, 2004, 101(3): 613-619.
[5] Syro LV, Rotondo F, Camargo M, et al.Temozolomide and Pituitary Tumors: Current Understanding, Unresolved Issues, and Future Directions[J]. Front Endocrinol (Lausanne), 2018 ,9:318.
[6] Ghazi AA, Rotondo F, Kovacs K, et al.Treatment of invasive silent somatotroph pituitary adenoma with temozolomide. Report of a caseand review of the literature[J]. Endocr Pathol,2015,26(2):135-139.
[7] McCormack AI, McDonald KL, Gill AJ, et al. Low O6-methylguanine-DNA methyltransferase (MGMT) expression and response to temozolomide in aggressive pituitary tumours[J]. Clin Endocrinol (Oxf),2009,71(2):226-233.
[8] Syro LV, Ortiz LD, Scheithauer BW, et al.Treatment of pituitary neoplasms with temozolomide: a review[J]. Cancer,2011, 117(3):454-62.
[9] Raverot G, Sturm N, de Fraipont F, et al. Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience[J]. J Clin Endocrinol Metab,2010,95(10):4592-4599.
[10] Bush ZM, Longtine JA, Cunningham T, et al.Temozolomide treatment for aggressive pituitary tumors: correlation of clinical outcome with O(6)-methylguanine methyltransferase (MGMT) promoter methylation and expression[J]. J Clin Endocrinol Metab,2010,95(11):E280-290.
[11] Neff LM, Weil M, Cole A, Hedges TR, et al.Temozolomide in the treatment of an invasive prolactinoma resistant to dopamine agonists[J]. Pituitary,2007,10(1):81-86.
[12] Chen C, Yin S, Zhang S, et al.Treatment of aggressive prolactinoma with temozolomide: A case report and review of literature up to date[J]. Medicine (Baltimore),2017,96(47):e8733.
[13] Moisi M, Cruz AS, Benkers T, et al.Treatment of Aggressive Prolactin-Secreting Pituitary Adenomas with Adjuvant Temozolomide Chemotherapy: A Review[J]. Cureus, 2016 ,8(6):e658.
[14] Strowd RE, Salvatori R, Laterra JJ.Temozolomide retreatment in a recurrent prolactin-secreting pituitary adenoma: Hormonal and radiographic response[J]. J Oncol Pharm Pract, 2016;22(3):517-522.
[15] Bruno OD, Juárez-Allen L, Christiansen SB, et al.Temozolomide Therapy for Aggressive Pituitary Tumors: Results in a Small Series of Patients from Argentina[J]. Int J Endocrinol, 2015, 2015:587893.
[16] Ceccato F, Lombardi G, Manara R, et al.Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center[J]. J Neurooncol, 2015,122(1):189-196.
[17] Morin E, Berthelet F, Weisnagel J, et al.Failure of temozolomide and conventional doses of pegvisomant to attain biochemical control in a severe case of acromegaly[J]. Pituitary,2012,15(1):97-100.
[18] Jordan JT, Miller JJ, Cushing T, et al.Temozolomide therapy for aggressive functioning pituitary adenomas refractory to surgery and radiation: a case series[J]. Neurooncol Pract,2018,5(1):64-68.
[19] McCormack AI, Wass JA, Grossman AB,et al. Aggressive pituitary tumours: the role of temozolomide and the assessment of MGMT status[J]. Eur J Clin Invest, 2011,41:1133-1148.
[20] Zacharia BE, Gulati AP, Bruce JN,et al.High response rates and prolonged survival in patients with corticotroph pituitary tumors and refractory cushing disease from capecitabineand temozolomide (CAPTEM): a case series[J]. Neurosurgery, 2014,74(4):E447-E455.