• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.567-574
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• 2001

Objective : As for growth hormone(GH) secreting pituitary adenoma, it's remission should be declared on the basis of satisfactory controlling of the tumor, normalization of hormonal level, and symptomatic improvement of the patient. Several modalities of treatment have been applied and administered, and yet, this disease still remains as inveterate one to be fully treated. The purpose of this study is to evaluate the outcome of gamma knife radiosurgery(GKRS) for GH secreting pituitary adenoma, and to identify various factors affecting the outcome of the treatment. Method : A group of 24 out of 35 patients, treated by Leksell gamma knife unit during the period of March of 1992 through October of 1997, had been observed for more than two years. The mean target volume of microadenoma was $449.3mm^3(range 216-880mm^3)$, and that of macroadenoma was $3183.1mm^3(range 1456-13125mm^3)$. The tumor margin was covered with 50% isodose profile, and mean marginal dose was 25.2Gy(range 15-32.4Gy). The mean number of isocenter was 4.3(range 1-6). The exposed dose to the optic apparatus was less than 8Gy. The mean follow-up period was 37.8months(range 24-102months). Result : No patients showed any increase in the tumor volume during the follow-up period. And definite shrinkage of tumor volume(tumor volume reduction rate, TVRR : more than 50%) was obtained in 10 patients(41.7%). Twenty one patients(87.5%) had reduced hormonal level compared than pre-treatment level. Among them, normalization of the hormonal level was achieved in 12 patients(50%). Clinicoendocrinological remission was seen in 3 patients (12.5%). According to the results of statistical analysis, tumor volume(p=0.016),duration of symptoms(p=0.046), initial GH level(p=0.017), and the invasion of cavernous sinus(p=0.036) were significantly favorable to post-radiosurgical outcome. The TVRR was significantly related to post-radiosurgical reduction of serum GH level. Permanent complication was not seen. Conclusion : The authors concluded that GKRS is a safe and effective treatment modality for acromegaly. To otain the better outcome of GKRS in GH secreting pituitary adenoma, more careful and sophisticated treatment-planning is recommended.

• Radiation Oncology Journal
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• 제11권2호
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• pp.439-448
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• 1993

Leksell 감마나이프(B-형)가 1992년 3월 경희대학교 의과대학 병원에 설치되었다. 선택적 빔 Plugging방법을 이용하여 정상 민감 조직에 대한 저선량 분포를 현저히 줄일 수 있으며, 또한 치료 부위에 더 좋은 선량 분포를 얻을 수 있다. 저선량에 대한 여러가지 선량 분포의 변화에 대한 연구를 하였으며, 사용중인 KULA프로그램의 선량 분포 곡선을 평가하기 위해 필름을 이용한 방사선량 계측을 실시하였고, RFA-3자동 밀도 측정기를 이용하여 평가하였다. 1992년 3월부터 1993년 2월까지 1년동안 100명의 환자중 17명의 환자에 선택적 빔 차폐 방법이 적용되었다. 고선량 영역에서는 측정값과 프로그램에서 제공된 선량 분포가 잘 일치하였다. 뇌하수체 선종의 치료시 치료 부위가 클 경우에는 본 연구 방법의 적용이 매우 중요시 되었으며, 반면에 치료 영역이 작을 경우에는 적절한 헬맷의 선택이 중요함을 알 수 있었다. 치료 환자의 중요 민감 장기의 방사선 선량 평가에서는 뇌간에 3~12 Gy, 시신경 교차에 3~11.2 Gy이었다. 중추신경계 영역의 최적화된 치료를 위하여 다양한 Plugging형태를 임상에 적용하는 것이 방사선에 민감한 정상 조직을 보호하기 위해 매우 중요한 인자가 됨을 알았다.