The role of stereotactic radiotherapy in patients with growth hormone-secreting pituitary adenoma.

Abstract

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.

• Authors: Marco Losa, Lorenzo Gioia, Piero Picozzi, Alberto Franzin, Micol Valle, Massimo Giovanelli, Pietro Mortini
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 93 Issue 7 Pg. 2546-52 (Jul 2008) ISSN: 0021-972X [Print] United States
• PMID: 18413424 (Publication Type: Journal Article)

Chemical References

• Human Growth Hormone
• Insulin-Like Growth Factor I

Topics

• Adenoma (blood, pathology, surgery)
• Adult
• Female
• Growth Hormone-Secreting Pituitary Adenoma (blood, pathology, surgery)
• Human Growth Hormone (blood)
• Humans
• Insulin-Like Growth Factor I (analysis)
• Male
• Radiosurgery (adverse effects)
• Retrospective Studies