Doo-Sik Kong1, Young-Hoon Kim2, Yong Hwy Kim3, Kyu Yeon Hur4, Jung Hee Kim5, Min-Seon Kim6, Sun Ha Paek3, Do-Hoon Kwon2, Dong-Kyu Kim3, Jung-Il Lee7. 1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 4. Internal Medicine, Division of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 5. Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 6. Department of Internal Medicine, Division of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 7. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jilee@skku.edu.
Abstract
OBJECTIVE: Little is known about the long-term efficacy, prognostic factors, and tolerability of gamma knife radiosurgery (GKS) for acromegaly. The aim of this study was to investigate long-term hormonal effects, prognostic factors, and tolerability of GKS in patients with growth hormone-secreting adenoma. METHODS: A retrospective multicenter study over 25 years with a median follow-up of 85.2 months was performed. A total of 138 patients from 3 tertiary referral centers in South Korea were included in this study between 1991 and 2017. Main outcome measures were endocrine remission, endocrine control under somatostatin analogues, and hypopituitarism. RESULTS: With a mean follow-up period of 85.2 months (range, 12-304 months), overall median time to the endocrine remission and control under long-acting somatostatin analogues was 138 months and 96 months, respectively. Female sex, normal age-adjusted insulin growth factor-1 (IGF-1) ≤ 2, and GKS as an adjuvant treatment were significantly favorable factors for remission (P = 0.004, P = 0.001, P = 0.010, respectively). The early response group had a significantly lower proportion of normal age-adjusted IGF-1 levels >2 than did the late response group (22.2% vs. 51.7%, P = 0.035); also, the early response group had lower radiation dose than the late response group (24.3 Gy vs. 27.0 Gy, P = 0.003). The incidence of GKS-induced hypopituitarism (1 or more) was 12 of 138 patients (8.6%) at the last follow-up. CONCLUSIONS: In acromegalic patients, women with normal age-adjusted IGF-1 ≤ 2 and GKS as an adjuvant treatment have a better response to GKS. We should take into account the variability of radiosensitivity of the tumor according to the gender and IGF-1 level.
OBJECTIVE: Little is known about the long-term efficacy, prognostic factors, and tolerability of gamma knife radiosurgery (GKS) for acromegaly. The aim of this study was to investigate long-term hormonal effects, prognostic factors, and tolerability of GKS in patients with growth hormone-secreting adenoma. METHODS: A retrospective multicenter study over 25 years with a median follow-up of 85.2 months was performed. A total of 138 patients from 3 tertiary referral centers in South Korea were included in this study between 1991 and 2017. Main outcome measures were endocrine remission, endocrine control under somatostatin analogues, and hypopituitarism. RESULTS: With a mean follow-up period of 85.2 months (range, 12-304 months), overall median time to the endocrine remission and control under long-acting somatostatin analogues was 138 months and 96 months, respectively. Female sex, normal age-adjusted insulin growth factor-1 (IGF-1) ≤ 2, and GKS as an adjuvant treatment were significantly favorable factors for remission (P = 0.004, P = 0.001, P = 0.010, respectively). The early response group had a significantly lower proportion of normal age-adjusted IGF-1 levels >2 than did the late response group (22.2% vs. 51.7%, P = 0.035); also, the early response group had lower radiation dose than the late response group (24.3 Gy vs. 27.0 Gy, P = 0.003). The incidence of GKS-induced hypopituitarism (1 or more) was 12 of 138 patients (8.6%) at the last follow-up. CONCLUSIONS: In acromegalicpatients, women with normal age-adjusted IGF-1 ≤ 2 and GKS as an adjuvant treatment have a better response to GKS. We should take into account the variability of radiosensitivity of the tumor according to the gender and IGF-1 level.
Authors: Andrea Giustina; Garni Barkhoudarian; Albert Beckers; Anat Ben-Shlomo; Nienke Biermasz; Beverly Biller; Cesar Boguszewski; Marek Bolanowski; Jens Bollerslev; Vivien Bonert; Marcello D Bronstein; Michael Buchfelder; Felipe Casanueva; Philippe Chanson; David Clemmons; Maria Fleseriu; Anna Maria Formenti; Pamela Freda; Monica Gadelha; Eliza Geer; Mark Gurnell; Anthony P Heaney; Ken K Y Ho; Adriana G Ioachimescu; Steven Lamberts; Edward Laws; Marco Losa; Pietro Maffei; Adam Mamelak; Moises Mercado; Mark Molitch; Pietro Mortini; Alberto M Pereira; Stephan Petersenn; Kalmon Post; Manuel Puig-Domingo; Roberto Salvatori; Susan L Samson; Ilan Shimon; Christian Strasburger; Brooke Swearingen; Peter Trainer; Mary L Vance; John Wass; Margaret E Wierman; Kevin C J Yuen; Maria Chiara Zatelli; Shlomo Melmed Journal: Rev Endocr Metab Disord Date: 2020-09-10 Impact factor: 6.514
Authors: Felix Ehret; Markus Kufeld; Christoph Fürweger; Alfred Haidenberger; Paul Windisch; Susanne Fichte; Ralph Lehrke; Carolin Senger; David Kaul; Daniel Rueß; Maximilian Ruge; Christian Schichor; Jörg-Christian Tonn; Günter Stalla; Alexander Muacevic Journal: Cancers (Basel) Date: 2021-01-31 Impact factor: 6.639
Authors: Christopher S Graffeo; Diane Donegan; Dana Erickson; Paul D Brown; Avital Perry; Michael J Link; William F Young; Bruce E Pollock Journal: Neurosurgery Date: 2020-09-01 Impact factor: 5.315
Authors: Kerstin A Kessel; Christian D Diehl; Markus Oechsner; Bernhard Meyer; Jens Gempt; Claus Zimmer; Friederike Schmidt-Graf; Stephanie E Combs Journal: Cancers (Basel) Date: 2019-11-27 Impact factor: 6.639