Effect of photodynamic therapy on recurrent pituitary adenomas: clinical phase I/II trial - an early report

被引:29
作者
Marks, PV
Belchetz, PE
Saxena, A
Igbaseimokumo, U
Thomson, S
Nelson, M
Stringer, MR
Holroyd, JA
Brown, SB
机构
[1] Univ Leeds, Gen Infirm, Dept Neurosurg, Leeds LS1 3EX, W Yorkshire, England
[2] Univ Leeds, Gen Infirm, Dept Endocrinol, Leeds LS1 3EX, W Yorkshire, England
[3] Univ Leeds, Gen Infirm, Dept Neuroradiol, Leeds LS1 3EX, W Yorkshire, England
[4] Univ Leeds, Dept Phys Med, Leeds, W Yorkshire, England
[5] Univ Leeds, Sch Biochem & Mol Biol, Leeds, W Yorkshire, England
关键词
adjuvant therapy; photodynamic therapy; pituitary adenomas; recurrent;
D O I
10.1080/026886900417298
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Pituitary adenomas, although histologically benign, are not always curable by surgery alone, principally because of dural infiltration, as well as their peculiar anatomical location. Radiotherapy has been employed as an adjuvant therapy to address residual disease with favourable results. This approach is, however, not without side effects, and it cannot be repeated. We are therefore investigating the effectiveness of photodynamic therapy (PDT) on recurrent pituitary adenomas in humans. This study details the protocol applied to 12 patients with recurrent pituitary adenomas, which involved systemic administration of photosensitizer (Photofrin) followed, after a period of 24-48 h, by intraoperative illumination of the tumour bed using 630 nm laser light. The primary end points were visual, endocrine and radiological improvement. The incidence of side effects was also monitored. The longest follow-up is 2 years. Most patients suffering from visual acuity or field defects have shown improvement when followed for 12 months or more. Three patients showed complete recovery of their visual fields. All those who presented with functional adenomas have shown reduction in their hormone levels. Tumour volume, relative to the preoperative size, was 122, 87, 66, 60 and 46% at 4 days, and 3, 6, 18 and 24 months, respectively. One patient developed severe skin photosensitization due to early exposure to direct sunlight and three others displayed minor skin reactions. There was no treatment-related mortality or morbidity. One patient (operated transcranially) developed hemiparesis postoperatively, which recovered completely. We think this is unrelated to the treatment. This prospective study demonstrates that PDT may be safely applied to the pituitary fossa by the trans-sphenoidal route and indicates the need for a randomized, controlled trial in order to establish its therapeutic potential.
引用
收藏
页码:317 / 325
页数:9
相关论文
共 30 条
[1]   THE LONG-TERM SIDE-EFFECTS OF RADIATION-THERAPY FOR BENIGN BRAIN-TUMORS IN ADULTS [J].
ALMEFTY, O ;
KERSH, JE ;
ROUTH, A ;
SMITH, RR .
JOURNAL OF NEUROSURGERY, 1990, 73 (04) :502-512
[2]  
Bieri S, 1997, Cancer Radiother, V1, P706, DOI 10.1016/S1278-3218(97)82947-2
[3]   THE LONG-TERM EFFICACY OF CONSERVATIVE SURGERY AND RADIOTHERAPY IN THE CONTROL OF PITUITARY-ADENOMAS [J].
BRADA, M ;
RAJAN, B ;
TRAISH, D ;
ASHLEY, S ;
HOLMESSELLORS, PJ ;
NUSSEY, S ;
UTTLEY, D .
CLINICAL ENDOCRINOLOGY, 1993, 38 (06) :571-578
[4]   RISK OF 2ND BRAIN-TUMOR AFTER CONSERVATIVE SURGERY AND RADIOTHERAPY FOR PITUITARY-ADENOMA [J].
BRADA, M ;
FORD, D ;
ASHLEY, S ;
BLISS, JM ;
CROWLEY, S ;
MASON, M ;
RAJAN, B ;
TRAISH, D .
BRITISH MEDICAL JOURNAL, 1992, 304 (6838) :1343-1346
[5]  
DOUGHERTY TJ, 1978, CANCER RES, V38, P2628
[6]  
FLICKINGER JC, 1996, PITUITARY ADENOMAS, P475
[7]   Photosensitization of the endometrium with topical 5-aminolevulinic acid [J].
Gannon, MJ ;
Johnson, N ;
Roberts, DJH ;
Holroyd, JA ;
Vernon, DI ;
Brown, SB ;
Lilford, RJ .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1995, 173 (06) :1826-1828
[8]   RADIATION-INDUCED OPTIC NEUROPATHY - A MAGNETIC-RESONANCE-IMAGING STUDY [J].
GUY, J ;
MANCUSO, A ;
BECK, R ;
MOSTER, ML ;
SEDWICK, LA ;
QUISLING, RG ;
RHOTON, AL ;
PROTZKO, EE ;
SCHIFFMAN, J .
JOURNAL OF NEUROSURGERY, 1991, 74 (03) :426-432
[9]   RADIOTHERAPY OF PITUITARY-TUMORS [J].
HALBERG, FE ;
SHELINE, GE .
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA, 1987, 16 (03) :667-684
[10]   PHOTORADIATION THERAPY OF BLADDER-TUMORS [J].
HISAZUMI, H ;
MISAKI, T ;
MIYOSHI, N ;
WHITMORE, WF .
JOURNAL OF UROLOGY, 1983, 130 (04) :685-687