Clayton E Alonso1, Adomas Bunevicius2, Daniel M Trifiletti3, James Larner1, Cheng-Chia Lee4, Fu-Yuan Pai4, Roman Liscak5, Mikulas Kosak6, Hideyuki Kano7, Nathaniel D Sisterson7, David Mathieu8, L Dade Lunsford7, Jason P Sheehan9. 1. Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA. 2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 3. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA. 4. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 5. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 6. 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic. 7. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 8. Division of Neurosurgery, Centre de Recherche du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada. 9. University of Virginia, Charlottesville, VA, USA. jps2f@hscmail.mcc.virginia.edu.
Abstract
PURPOSE: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. METHODS: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. RESULTS: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. CONCLUSIONS: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.
PURPOSE: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. METHODS: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. RESULTS: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. CONCLUSIONS: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.
Authors: Laurence Katznelson; John L D Atkinson; David M Cook; Shereen Z Ezzat; Amir H Hamrahian; Karen K Miller Journal: Endocr Pract Date: 2011 Jul-Aug Impact factor: 3.443
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Authors: Laurence Katznelson; Edward R Laws; Shlomo Melmed; Mark E Molitch; Mohammad Hassan Murad; Andrea Utz; John A H Wass Journal: J Clin Endocrinol Metab Date: 2014-10-30 Impact factor: 5.958
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