Successful treatment of medically and surgically refractory lymphocytic hypophysitis with fractionated stereotactic radiotherapy: a single-center experience and systematic literature review,Pituitary

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Successful treatment of medically and surgically refractory lymphocytic hypophysitis with fractionated stereotactic radiotherapy: a single-center experience and systematic literature review
Pituitary ( IF 3.3 ) Pub Date : 2024-01-25 , DOI: 10.1007/s11102-023-01367-8
Mehdi Khaleghi ₁ , Guilherme Finger ₁ , Kyle C Wu ₁ , Vikas Munjal ₂ , Luma Ghalib ₃ , Peter Kobalka ₄ , Dukagjin Blakaj ₅ , Khaled Dibs ₅ , Ricardo Carrau ₆ , Daniel Prevedello ₁

Affiliation

Purpose

To explore the potential role of focused radiotherapy in managing the lymphocytic hypophysitis (LH) refractory to medical therapy and surgery.

Method

A systematic literature review was conducted following PRISMA guidelines to identify the studies on radiation treatment for hypophysitis, along with the experience in our institution.

Results

The study included eight patients, three from our institution and five from existing literature. The age at presentation ranged from 37 to 75 years old, with a median age of 58. The presenting symptoms involved headache in seven patients and diplopia in two patients. Pre-radiation visual field defects were noticed in four patients. All patients exhibited variable degrees of hypopituitarism before radiation, with oral corticosteroids being the initial medical treatment. Immunosuppressive therapy was attempted in two patients prior to radiation. Seven patients had a history of transsphenoidal surgery with a histologically confirmed LH. Three patients underwent stereotactic radiosurgery (SRS), while the remaining received FSRT, with a mean irradiation volume of 2.2 cm³. A single-session total dose of 12 -15 Gy was administered in the SRS group. In the FSRT group, doses ranged from 24 to 30 Gy with a median dose of 25 Gy, delivered in 2 Gy fractions. Four patients achieved a resolution of visual field defects, while another two patients demonstrated improvement in their associated focal neurologic deficits. No change in pre-existing endocrine status was shown after radiation, except in one patient. Clinical response was achieved in seven patients after a single course of radiation, while one patient required the second course. Six patients remained stable on low-dose glucocorticoid during at least a 12-month follow-up period, and one discontinued it entirely without experiencing relapse. Three patients demonstrated a complete radiologic response, while the remaining showed a partial radiologic response.

Conclusions

Focused radiation, including FSRT, can play a role in symptomatic relief, effective mass shrinkage, and minimizing radiation exposure to critical surrounding structures in patients with refractory LH. However, further research efforts are necessary to better clarify its effects and optimal dose planning.

中文翻译：

分次立体定向放射治疗成功治疗内科和外科难治性淋巴细胞性垂体炎：单中心经验和系统文献综述

目的

探讨聚焦放疗在治疗药物治疗和手术难治性淋巴细胞性垂体炎 (LH) 中的潜在作用。

方法

根据 PRISMA 指南进行了系统的文献综述，以确定垂体炎放射治疗的研究以及我们机构的经验。

结果

该研究包括八名患者，其中三名来自我们机构，五名来自现有文献。就诊年龄为 37 至 75 岁，中位年龄为 58 岁。7 名患者出现头痛，2 名患者出现复视。四名患者注意到放射前视野缺陷。所有患者在放疗前均表现出不同程度的垂体功能低下，口服皮质类固醇是最初的治疗方法。在放疗前，两名患者尝试了免疫抑制治疗。 7 名患者有经蝶手术史，并经组织学证实患有 LH。 3名患者接受立体定向放射外科手术（SRS），其余患者接受FSRT，平均照射体积为2.2 cm ³ 。 SRS组的单次总剂量为12 -15 Gy。在 FSRT 组中，剂量范围为 24 至 30 Gy，中位剂量为 25 Gy，分 2 Gy 进行。四名患者的视野缺陷得到了解决，另外两名患者的相关局灶性神经功能缺陷得到了改善。除一名患者外，放疗后原有的内分泌状态没有变化。七名患者在接受一个疗程的放射治疗后获得了临床缓解，而一名患者则需要接受第二个疗程。 6 名患者在至少 12 个月的随访期间使用低剂量糖皮质激素保持稳定，其中 1 名患者完全停药，没有出现复发。三名患者表现出完全的放射学反应，而其余患者表现出部分放射学反应。