neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-4-54-64neurosurgery-1610Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEОпыт применения темозоломида в лечении агрессивных аденом гипофизаExperience using temozolomide in the treatment of aggressive pituitary adenomashttps://orcid.org/0000-0001-9333-9473КалининП. Л.KalininP. L.

125047; ул. 4-я Тверская-Ямская, 16; Москва

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

https://orcid.org/0000-0003-4480-1902АстафьеваЛ. И.AstafyevaL. I.

125047; ул. 4-я Тверская-Ямская, 16; Москва

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

https://orcid.org/0000-0002-9789-3452ЧерновИ. В.ChernovI. V.

Илья Валерьевич Чернов

125047; ул. 4-я Тверская-Ямская, 16; Москва

Ilya Valeryevich Chernov

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

ichernov@nsi.ruhttps://orcid.org/0000-0002-7651-4214КобяковГ. Л.KobyakovG. L.

125047; ул. 4-я Тверская-Ямская, 16; Москва

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

https://orcid.org/0000-0002-5323-1000ФомичевД. В.FomichevD. V.

125047; ул. 4-я Тверская-Ямская, 16; Москва

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

https://orcid.org/0000-0002-4240-5036ТрунинЮ. Ю.TruninYu. Yu.

125047; ул. 4-я Тверская-Ямская, 16; Москва

125047; 16 4th Tverskaya-Yamskaya St.; Moscow

ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation2024240120252645464Copyright © Калинин П.Л., Астафьева Л.И., Чернов И.В., Кобяков Г.Л., Фомичев Д.В., Трунин Ю.Ю., 20252025Калинин П.Л., Астафьева Л.И., Чернов И.В., Кобяков Г.Л., Фомичев Д.В., Трунин Ю.Ю.Kalinin P.L., Astafyeva L.I., Chernov I.V., Kobyakov G.L., Fomichev D.V., Trunin Y.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1610   Введение

   Введение. Термин «агрессивная аденома гипофиза» возник в результате преобразования термина «атипичная аденома гипофиза», который использовался в классификации Всемирной организации здравоохранения для аденом гипофиза с более высоким индексом мечения Ki-67 (≥3 %), увеличенным числом митозов и экспрессией белка р53. Однако не все опухоли с такими признаками являлись агрессивными, и в настоящее время согласно руководству Европейского общества эндокринологов по лечению агрессивных опухолей гипофиза и карцином 2018 г. агрессивные опухоли гипофиза определяют как опухоли, характеризующиеся инвазивным и необычно быстрым или клинически значимым ростом, который происходит несмотря на использование стандартных протоколов лечения (фармакологического, хирургического и лучевого). На сегодняшний день в литературе имеется множество работ, описывающих различные схемы применения темозоломида и показания к его назначению. Эффективность терапии, по данным разных авторов, колеблется от 29 до 81 %, при этом средняя эффективность варьирует в пределах 40–45 %.

   Цель работы – представить собственный опыт применения темозоломида в лечении пациентов с агрессивными опухолями гипофиза.

   Материалы и методы

   Материалы и методы. В исследование были включены 3 пациента: 1 мужчина (45 лет) и 2 женщины (61 и 29 лет). Всем пациентам сначала была проведена хирургическая резекция опухоли с последующей лучевой терапией. Решение о начале лечения темозоломидом было принято соответствующей медицинской комиссией под наблюдением местного комитета по этике.

   Результаты

   Результаты. У всех пациентов достигнут хороший ответ на терапию темозоломидом в виде уменьшения размера опухоли и снижения уровня пролактина в случаях пролактиномы.

   Заключение

   Заключение. Наиболее важным в лечении пациентов с агрессивными аденомами гипофиза является их ранняя диагностика, возможность которой зависит от выявления специфических идентифицирующих маркеров агрессивности, однако на данный момент такие маркеры, к сожалению, не обнаружены.

   Background

   Background. The term “aggressive pituitary adenoma” arose as a result of transforming the term “atypical pituitary adenoma”, which was used in WHO classification for pituitary adenomas with specifications of higher labeling index Ki-67 (≥3 %) and increased number of mitoses with expression of the p53 proteins. However, not all tumors with these features were aggressive, and currently, according to the European Society of Endocrinology Clinical Practice Guideline for the management of aggressive pituitary tumors and carcinomas (2018), aggressive pituitary tumors are labeled as tumors that have invasive and unusually rapid or clinically significant growth which occurs despite the use of standard treatment protocols (pharmacological, surgical and radiation). Till date, there are numerous papers in literature describing various schemes and indications for the use of temozolomide. The efficiency of ongoing therapy, according to different authors, varies from 29 to 81 %, with an average effectiveness ranging between 40–45 %.

   Aim

   Aim. To present our own experience of using temozolomide in the treatment of patients with aggressive pituitary tumors.

   Materials and methods

   Materials and methods. Three patients were included in the study, one male (45 years old) and 2 females (61 and 29 years old). All three patients included in the study first underwent surgical resection followed by radiation therapy if no response / hormonal activity didn’t resume. The decision to start temozolomide protocol was held by concerned medical commission under supervision of local ethical committee.

   Results

   Results. All patients responded well to temozolomide therapy with decrease in the size of tumor and decrease in levels of prolactin in cases of prolactinoma.

   Conclusion

   Conclusion. The most important step in treating patients with aggressive pituitary adenomas is their early diagnosis, which could be possible only if the specific identifying markers of aggressiveness were found, which unfortunately are not found yet.

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The authors declare that there are no conflicts of interest present.