{"id":20221,"date":"2025-09-03T15:25:28","date_gmt":"2025-09-03T15:25:28","guid":{"rendered":"https:\/\/cancercentertec100.com\/?p=20221"},"modified":"2025-09-03T15:26:27","modified_gmt":"2025-09-03T15:26:27","slug":"radiocirugia-en-tumores-hipofisiarios","status":"publish","type":"post","link":"https:\/\/cancercentertec100.com\/en\/investigacion\/radiocirugia-en-tumores-hipofisiarios\/","title":{"rendered":"RADIOCIRUG\u00cdA EN TUMORES HIPOFISIARIOS"},"content":{"rendered":"
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Por: Dra. Yuliana Guiza Gonz\u00e1lez
Coordinadora de Cl\u00ednica de Neurolog\u00eda
Radio onc\u00f3loga con Alta Especialidad en Radiocirug\u00eda<\/em><\/span><\/figure>\n
Los adenomas hipofisiarios son tumores benignos que se originan en la adenohip\u00f3fisis y constituyen el 10-15% de todas las neoplasias intracraneales primarias. Su prevalencia en estudios es de 1 caso por cada 1000 habitantes siendo en su mayor\u00eda lesiones benignas y de crecimiento lento.<\/figure>\n
CLASIFICACI\u00d3N CL\u00cdNICA NO SECRETORES<\/strong><\/span>
40-50% suelen manifestarse por efecto de masa (cefalea, alteraciones visuales, hipopituitarismo)
\u2022 Tumores residuales o recurrentes tras cirug\u00eda;
\u2022 Casos no aptos para cirug\u00eda por comorbilidad o localizaci\u00f3n.<\/figure>\n
SECRETORES<\/span><\/strong>
50-60% subdivididos
\u2022 Prolactinomas refractarios a agonistas dopamin\u00e9rgicos siendo los m\u00e1s frecuentes 40%;
\u2022 Adenomas secretores de GH tras cirug\u00eda incompleta o fracaso m\u00e9dico asociado en un 20% (acromegalia);
\u2022 Adenomas secretores de ACTH persistentes o recurrentes 10-15% responsables de enfermedad de Cushing;
\u2022 Menos frecuentes gonadotropos, tirotropos.<\/figure>\n
EFECTIVIDAD<\/span><\/strong>
Control tumoral radiol\u00f3gico 90-95% a 10 a\u00f1os
Control bioqu\u00edmico funcional
\u2022 Prolactina normalizada 40-60%;
\u2022 Acromegalia: 40-50% normalizaci\u00f3n IGF-;
\u2022 Cushing_ 50-70% con reducci\u00f3n ACTH y cortisol.\u00a0<\/p>\n

 <\/p>\n

Latencia de respuesta meses a a\u00f1os especialmente en adenomas secretores.<\/p>\n

La dosis va desde 12-25 Gy en dosis \u00fanica ya que la limitaci\u00f3n espec\u00edfica ser\u00e1 la dosis a la v\u00eda visual considerando que la dosis m\u00e1xima al quiasma\/nervio \u00f3ptico < 8-10 Gy en una fracci\u00f3n. Es indispensable contar con una resonancia magn\u00e9tica de alta resoluci\u00f3n para definir hip\u00f3fisis, tallo y quiasma.<\/p>\n

EFECTOS ADVERSOS<\/span><\/strong>
\u2022 Hipopituitarismo: complicaci\u00f3n m\u00e1s frecuente 20-40% a 10 a\u00f1os;
\u2022 Neuropat\u00eda \u00f3ptica < 2% si se respeta l\u00edmite de dosis;
\u2022 Da\u00f1o pares craneales III, IV, VI a considerar en aquellos adenomas hipofisarios con invasi\u00f3n cavernosa;
\u2022 Transformaci\u00f3n maligna muy poco frecuente sin evidencia fuerte.<\/p>\n

CONTRAINDICACIONES RELATIVAS<\/span><\/strong>
Compresi\u00f3n quiasm\u00e1tica severa ya que requiere cirug\u00eda previa, invasi\u00f3n cavernosa extensa con cercan\u00eda al nervio \u00f3ptico pues por la distribuci\u00f3n de dosis no lograr\u00eda la restricci\u00f3n al nervio \u00f3ptico condicionando toxicidad asociada.<\/p>\n

CONCLUSI\u00d3N<\/span><\/strong>
La radiocirug\u00eda en adenomas de hip\u00f3fisis es un tratamiento seguro con buen control tumoral una alternativa de tratamiento en tumores residuales, recurrentes o cuando el tratamiento m\u00e9dico fracasa ya que el principal riesgo a largo plazo es el hipopituitarismo por lo que requiere seguimiento endocrinol\u00f3gico de por vida.<\/p>\n

Bibliograf\u00eda:
<\/span><\/strong>Lunsford LD, Sheehan JP Intracranial Stereotactic Radiosurgery 2nd. Ed. Thieme 2015
<\/span>Loeffler JS, Kondziolka D (eds.)\u00a0 Radiosurgery McGraw Hill
<\/span>De Salles AAF, Gorgulho A Slotman BJ, et al Shaped Beam Radiorugery State of the Art Springer<\/span><\/div>\n<\/figure>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

Los adenomas hipofisiarios son tumores benignos que se
\noriginan en la adenohip\u00f3fisis y constituyen el 10-15% de
\ntodas las neoplasias intracraneales primarias. Su prevalencia
\nen estudios es de 1 caso por cada 1000 habitantes siendo en
\nsu mayor\u00eda lesiones benignas y de crecimiento lento.<\/p>","protected":false},"author":1,"featured_media":20222,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23,357,394,24],"tags":[419,391],"class_list":["post-20221","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-informacion-sobre-el-cancer","category-investigacion","category-radiocirugia","category-tratamiento","tag-hipofisiarios","tag-radiocirugia"],"yoast_head":"\nRADIOCIRUG\u00cdA EN TUMORES HIPOFISIARIOS<\/title>\n<meta name=\"description\" content=\"Los adenomas hipofisiarios son tumores benignos que se originan en la adenohip\u00f3fisis y constituyen el 10-15% de todas las neoplasias intracraneales primarias. 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