BACKGROUND: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion. OBJECTIVE: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment. DESIGN: Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. PATIENTS then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. SETTING: Norwegian National Center for gamma knife treatment. PATIENTS: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up. RESULTS: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period. CONCLUSION: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.
BACKGROUND: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion. OBJECTIVE: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment. DESIGN: Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. PATIENTS then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. SETTING: Norwegian National Center for gamma knife treatment. PATIENTS: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up. RESULTS:Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period. CONCLUSION: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.
Authors: Henry Ka-Fung Mak; Shui-Wun Lai; Wenshu Qian; Stanley Xu; Elizabeth Tong; May Lee Vance; Edward Oldfield; John Jane; Jason Sheehan; Kelvin K W Yau; Max Wintermark Journal: Pituitary Date: 2015-08 Impact factor: 4.107
Authors: Jay Jagannathan; Adam S Kanter; Claire Olson; Jonathan H Sherman; Edward R Laws; Jason P Sheehan Journal: J Neurooncol Date: 2008-06-21 Impact factor: 4.130