| Popis: |
BACKGROUND There is relatively little information regarding the efficacy of temozolomide (TMZ) for pituitary adenomas; less than 100 cases treated with TMZ are reported, with a variable response rate of 50-75%, depending on response criteria. METHODS Retrospective review of patients with pituitary tumors treated with TMZ at University Hospitals Cleveland Medical Center. RESULTS Three patients were identified. Patient age at the time of TMZ treatment was 20, 51, and 70 years. Two were female, one male. Histology was prolactinoma in two and Cushing’s disease in one. Each patient had undergone multiple surgeries and medical treatments with insufficient response or relapse. Two had received radiosurgery; it was withheld in a 20 year old male due to concerns of optic nerve radiation injury. A 5d q 28d regimen was used in each, beginning at 150mg/M2 daily for initial dose then increased to 200mg/M2 daily. Diplopia and headache improved in one patient, whose serum prolactin significantly declined (222.8 to 81.9 ng/ml). Headache resolved in another patient and prolactin remained stable. In the patient with Cushing’s disease, headaches improved and ACTH remained elevated but stable. The tumor remained stable on MRI in each patient. There were no adverse effects from TMZ used over 5 to 29 months. CONCLUSIONS Our clinical experience adds to the limited published information regarding the effectiveness of TMZ for pituitary adenomas. In our case series, clinical improvement was noted in each of 3 patients with pituitary adenomas that had failed or recurred after other therapies. Serum prolactin significantly declined in one patient. This data suggests a beneficial role for TMZ in treating pituitary adenomas. |
