PNA Medical Corner: Stereotactic Radiosurgery for Acromegaly

The PNA Medical Corner showcases an article co-authored by two PNA members: Drs. Jason Sheehan and Christopher Cifarelli. The study looks at stereotactic radiosurgery for acromegaly and concludes that this type of procedure is effective for patients with persistent or recurrent acromegaly after surgical resection.

Neurosurgery. 2018 May 10. doi: 10.1093/neuros/nyy178. [Epub ahead of print]
Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study.
Ding D1, Mehta GU2, Patibandla MR3, Lee CC4, Liscak R5, Kano H6, Pai FY4, Kosak M7, Sisterson ND6, Martinez-Alvarez R8, Martinez-Moreno N8, Mathieu D9, Grills IS10, Blas K10, Lee K10, Cifarelli CP11, Katsevman GA11, Lee JYK12, McShane B12, Kondziolka D13, Lunsford LD6, Vance ML3,14, Sheehan JP3.

Abstract

BACKGROUND:

Stereotactic radiosurgery (SRS) is a treatment option for persistent or recurrent acromegaly secondary to a growth hormone secreting pituitary adenoma, but its efficacy is inadequately defined.

OBJECTIVE:

To assess, in a multicenter, retrospective cohort study, the outcomes of SRS for acromegaly and determine predictors.

METHODS:

We pooled and analyzed data from 10 participating institutions of the International Gamma Knife Research Foundation for patients with acromegaly who underwent SRS with endocrine follow-up of ≥6 mo.

RESULTS:

The study cohort comprised 371 patients with a mean endocrine follow-up of 79 mo. IGF-1 lowering medications were held in 56% of patients who were on pre-SRS medical therapy. The mean SRS treatment volume and margin dose were 3.0 cm3 and 24.2 Gy, respectively. The actuarial rates of initial and durable endocrine remission at 10 yr were 69% and 59%, respectively. The mean time to durable remission after SRS was 38 mo. Biochemical relapse after initial remission occurred in 9%, with a mean time to recurrence of 17 mo. Cessation of IGF-1 lowering medication prior to SRS was the only independent predictor of durable remission (P = .01). Adverse radiation effects included the development of ≥1 new endocrinopathy in 26% and ≥1 cranial neuropathy in 4%.

CONCLUSION:

SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.

PMID:29757421 DOI:10.1093/neuros/nyy178

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