U J Knappe1, D Petroff2, M Quinkler3, S M Schmid4, C Schöfl5, J Schopohl6, M R Stieg7, A Tönjes8. 1. Department of Neurosurgery, Johannes Wesling Hospital, Minden, Germany. 2. Clinical Trial Centre, University of Leipzig, Leipzig, Germany. 3. Endocrinology in Charlottenburg, Stuttgarter Platz, Berlin, Germany. 4. Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany. 5. Centers of Endocrinology and Metabolism, Bamberg and Erlangen, Bamberg, Germany. 6. Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, Munich, Germany. 7. Max-Planck-Institute of Psychiatry, Munich, Germany. 8. University of Leipzig Medical Center, Medical Department III - Endocrinology, Nephrology, Rheumatology, Leipzig, Germany.
Abstract
BACKGROUND: If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated. OBJECTIVE: To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function. DESIGN AND METHODS: A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0-45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication. RESULTS: Time between radiotherapy and last follow-up was 13.0 ± 8.2 years for FRT (n = 233) and 8.9 ± 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9-16.2) ng/mL for FRT and 3.5 (1.8-6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is -18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30-1.00, P = 0.049) in SRS compared to FRT patients. CONCLUSION: Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.
BACKGROUND: If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated. OBJECTIVE: To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function. DESIGN AND METHODS: A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0-45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication. RESULTS: Time between radiotherapy and last follow-up was 13.0 ± 8.2 years for FRT (n = 233) and 8.9 ± 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9-16.2) ng/mL for FRT and 3.5 (1.8-6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is -18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30-1.00, P = 0.049) in SRS compared to FRT patients. CONCLUSION: Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.
Authors: Thomas Cuny; Thomas Graillon; Célines Defilles; Rakesh Datta; Shengwen Zhang; Dominique Figarella-Branger; Henry Dufour; Grégory Mougel; Thierry Brue; Tanya Landsman; Heather A Halem; Michael D Culler; Anne Barlier; Alexandru Saveanu Journal: Pituitary Date: 2021-01-12 Impact factor: 4.107
Authors: Maria Fleseriu; Beverly M K Biller; Pamela U Freda; Monica R Gadelha; Andrea Giustina; Laurence Katznelson; Mark E Molitch; Susan L Samson; Christian J Strasburger; A J van der Lely; Shlomo Melmed Journal: Pituitary Date: 2020-10-20 Impact factor: 4.107
Authors: Maria Fleseriu; Dagmar Führer-Sakel; Aart J van der Lely; Laura De Marinis; Thierry Brue; Joli van der Lans-Bussemaker; Judith Hey-Hadavi; Cecilia Camacho-Hubner; Michael P Wajnrajch; Srinivas Rao Valluri; Andrew Anthony Palladino; Roy Gomez; Roberto Salvatori Journal: Eur J Endocrinol Date: 2021-08-27 Impact factor: 6.664