CONTEXT: Single-session stereotactic radiotherapy (SR) may be a potential adjuvant treatment in acromegaly. OBJECTIVE: We analyzed the safety and efficacy of SR in patients who had previously received maximal surgical debulking at our center. DESIGN: The study was a retrospective analysis of hormonal, radiological, and ophthalmologic data collected in a predefined protocol from 1994 through 2006. SETTING: The study was performed at a university hospital. PATIENTS: Eighty-three acromegalic patients, 52 women and 31 men, with a mean age of 42.6 +/- 1.2 yr, participated in the study. The median follow-up was 69 months (interquartile range 44-107 months). INTERVENTION: The patients were treated with SR for residual or recurrent GH-secreting adenoma. MAIN OUTCOME MEASURE: Normalization of age- and sex-adjusted IGF-I levels together with a basal GH level below 2.5 microg/liter without concomitant GH-suppressive drugs was the goal of therapy. RESULTS: Fifty patients (60.2%) reached the main outcome of the study. The rate of remission was 52.6% at 5 yr [95% confidence interval (CI) 40.6-64.6%]. Another 13 patients (15.7%), who were resistant to somatostatin analogs, were in remission after SR. Multivariate analysis showed that low basal GH and IGF-I levels were associated with a favorable outcome. No serious side effects occurred after SR. The 5-yr cumulative risk of new onset hypogonadism, hypothyroidism, or hypoadrenalism was 3.6% (95% CI 0-8.6%), 3.3% (95% CI 0-7.7%), and 4.9% (95% CI 0-10.4%), respectively. CONCLUSION: In a highly selected group of acromegalic patients, SR treatment had good efficacy and safety. This may lead to reconsider the role of SR in the therapeutic algorithm of acromegaly.
CONTEXT: Single-session stereotactic radiotherapy (SR) may be a potential adjuvant treatment in acromegaly. OBJECTIVE: We analyzed the safety and efficacy of SR in patients who had previously received maximal surgical debulking at our center. DESIGN: The study was a retrospective analysis of hormonal, radiological, and ophthalmologic data collected in a predefined protocol from 1994 through 2006. SETTING: The study was performed at a university hospital. PATIENTS: Eighty-three acromegalicpatients, 52 women and 31 men, with a mean age of 42.6 +/- 1.2 yr, participated in the study. The median follow-up was 69 months (interquartile range 44-107 months). INTERVENTION: The patients were treated with SR for residual or recurrent GH-secreting adenoma. MAIN OUTCOME MEASURE: Normalization of age- and sex-adjusted IGF-I levels together with a basal GH level below 2.5 microg/liter without concomitant GH-suppressive drugs was the goal of therapy. RESULTS: Fifty patients (60.2%) reached the main outcome of the study. The rate of remission was 52.6% at 5 yr [95% confidence interval (CI) 40.6-64.6%]. Another 13 patients (15.7%), who were resistant to somatostatin analogs, were in remission after SR. Multivariate analysis showed that low basal GH and IGF-I levels were associated with a favorable outcome. No serious side effects occurred after SR. The 5-yr cumulative risk of new onset hypogonadism, hypothyroidism, or hypoadrenalism was 3.6% (95% CI 0-8.6%), 3.3% (95% CI 0-7.7%), and 4.9% (95% CI 0-10.4%), respectively. CONCLUSION: In a highly selected group of acromegalicpatients, SR treatment had good efficacy and safety. This may lead to reconsider the role of SR in the therapeutic algorithm of acromegaly.
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: E Ghigo; B M K Biller; A Colao; I A Kourides; N Rajicic; R K Hutson; L De Marinis; A Klibanski Journal: J Endocrinol Invest Date: 2009-12-04 Impact factor: 4.256