Abstract
Primary treatment for growth-hormone secreting pituitary adenomas usually involves
surgery, with treatment options for recurrent and persistent disease including repeat
surgery, medication and radiation therapy. The majority of previously published series
for radiation therapy in acromegaly in the past 20 years have been based on Gamma-Knife (Elekta, Stockholm, Sweden) surgery. To our knowledge,
we present the largest series of linear accelerator-based treatment for this disease,
with a review of 121 patients treated at our institution; since 1990, 86 patients
underwent stereotactic radiosurgery (SRS), 10 patients underwent fractionated stereotactic
radiotherapy (FSRT), and for the purposes of comparison we also reviewed 25 patients
who underwent conventional radiotherapy prior to 1990. Tumour volume control in all
three groups was excellent and consistent with previously reported literature – only
three of 86 (4%) patients undergoing SRS had a documented increase in tumour size,
and none of the patients undergoing FSRT had a documented increase in size following
a median follow-up of 5.5 and 5.1 years for SRS and FSRT, respectively. Target growth hormone levels of <2.5 ng/mL were met by 12 of 86 (14%) of the SRS group, and by two of 10 (20%) in the FSRT
group. Target insulin-like growth factor-1 levels of age and sex matched controls
were achieved in 16 of 86 patients (18.6%) post-SRS and five of 10 patients (50%)
post-FSRT. New hormonal deficits requiring replacement therapy were identified in
17 of 86 (19.8%) patients post-SRS which is consistent with previously published radiosurgical
series. Identified non-hormonal morbidity was low (<5%).
Keywords
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References
- Early descriptions of acromegaly and gigantism and their historical evolution as clinical entities.Neurosurg Focus. 2010; 29: E1
- Does acromegaly enhance mortality?.Rev Endocr Metab Disord. 2008; 9: 33-39
- Medical consequences of acromegaly: what are the effects of biochemical control?.Rev Endocr Metab Disord. 2008; 9: 21-31
- Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications.Horm Metab Res. 2003; 35: 712-725
- Current management practices for acromegaly: an international survey.Pituitary. 2011; 14: 125-133
- The OASIS study: therapeutic management of acromegaly in standard clinical practice. Assessment of the efficacy of various treatment strategies.Endocrinol Nutr. 2011; 58: 478-486
- The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’.Eur J Endocrinol. 2005; 152: 379-387
- Optimizing acromegaly treatment.Front Horm Res. 2010; 38: 174-183
- Somatostatin analogs in acromegaly.J Clin Endocrinol Metab. 2002; 87: 3013-3018
- Cost-effectiveness of lanreotide autogel in treatment algorithms of acromegaly.Expert Rev PharmacoEcon Outcomes Res. 2009; 9: 223-234
- Radiation techniques for acromegaly.Radiat Oncol. 2011; 6: 167
- Reference ranges of serum IGF-1 and IGFBP-3 levels in a general adult population: results of the Study of Health in Pomerania (SHIP).Growth Horm IGF Res. 2008; 18: 228-237
- Treatment of persistent and recurrent acromegaly.J Clin Neurosci. 2011; 18: 181-190
- Stereotactic irradiation of GH-secreting pituitary adenomas.Int J Endocrinol. 2012; 2012: 482861
- Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study.Cancer. 2006; 107: 1355-1364
- Stereotactic radiosurgery XVI: a treatment for previously irradiated pituitary adenomas.J Clin Endocrinol Metab. 2003; 88: 5334-5340
- Proton stereotactic radiosurgery in management of persistent acromegaly.Endocr Pract. 2007; 13: 726-734
- Efficacy and safety of CyberKnife radiosurgery for acromegaly.Pituitary. 2007; 10: 19-25
- GH and mortality in acromegaly.J Endocrinol Invest. 2005; 28: 75-77
- Criteria for cure of acromegaly: a consensus statement.J Clin Endocrinol Metab. 2000; 85: 526-529
- A systematic analysis of disease control in acromegaly treated with radiosurgery.Neurosurg Focus. 2010; 29: E13
- Gamma knife radiosurgery for acromegaly.Int J Endocrinol. 2012; 2012: 821579
- Gamma knife radiosurgery for clinically persistent acromegaly.J Neurooncol. 2012; 109: 71-79
- Gammaknife radiosurgery in patients with acromegaly.J Clin Neurosci. 2011; 18: 1616-1620
- Stereotactic radiosurgery with the CyberKnife for pituitary adenomas.J Korean Neurosurg Soc. 2009; 45: 157-163
- Image-guided stereotactic radiosurgery with the CyberKnife for pituitary adenomas.Minim Invasive Neurosurg. 2005; 48: 91-96
- Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission.J Neurosurg. 2007; 106: 833-838
- Role of stereotactic radiosurgery in the management of pituitary adenomas.Nat Rev Endocrinol. 2010; 6: 214-223
- Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery.Neurosurgery. 2008; 62 ([discussion 1269–1270]): 1262-1269
- Radiosurgery and carcinogenesis risk.Prog Neurol Surg. 2008; 21: 207-213
- Transient MR changes and symptomatic epilepsy following gamma knife treatment of a residual GH-secreting pituitary adenoma in the cavernous sinus.Acta Neurochir (Wien). 2006; 148 ([discussion 908]): 903-908
- Octreotide may act as a radioprotective agent in acromegaly.J Clin Endocrinol Metab. 2000; 85: 1287-1289
- Effect of somatostatin on repair of ionizing radiation-induced DNA damage in pituitary adenoma cells GH3.Physiol Res. 2008; 57: 225-235
- Lanreotide promotes apoptosis and is not radioprotective in GH3 cells.Endocr Relat Cancer. 2009; 16: 1045-1055
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