Abstract
Growth hormone (GH)-secreting pituitary adenomas represent a common source of GH excess in patients with acromegaly. Whereas surgical extirpation of the culprit lesion is considered first-line treatment, as many as 19% of patients develop recurrent symptoms due to regrowth of previously resected adenomatous tissue or to continued growth of the surgically inaccessible tumor. Although medical therapies that suppress GH production can be effective in the management of primary and recurrent acromegaly, these therapies are not curative, and lifelong treatment is required for hormonal control. Stereotactic radiosurgery has emerged as an effective adjunctive treatment modality, and is an appealing alternative to conventional fractionated radiation therapy. The authors reviewed the growing body of literature concerning the role of radiosurgical procedures in the treatment armamentarium of acromegaly, and identified more than 1350 patients across 45 case series. In this review, the authors report that radiosurgery offers true hormonal normalization in 17% to 82% of patients and tumor growth control in 37% to 100% of cases across all series, while minimizing adverse complications. As a result, stereotactic radiosurgery represents a safe and effective treatment option in the multimodal management of primary or recurrent acromegaly secondary to GH-secreting pituitary adenomas.
Highlights
We review the results from this robust body of literature, and highlight postradiosurgical rates of endocrinological remission and tumor growth control as well as assess the potential advantages and limitations of SRS in the multimodal management of acromegaly
Pertinent clinical characteristics extracted from each report include the stereotactic radiosurgical unit; marginal radiation dose; rate of pituitary suppressive medication used during SRS; tumor size and prevalence of cavernous sinus invasion; rates of endocrinological remission and tumor growth control; and SRS-associated complications
Endocrinological Remission and Control Whereas the precise criteria for characterizing endocrinological remission following SRS were inconsistent across the case series, the most widely accepted definition is a random GH level less than 2 ng/ml or a GH level less than 1 ng/ml following an oral glucose tolerance test in addition to a normal IGF-I level when controlled for age and sex
Summary
A PubMed search (National Library of Medicine) was performed to identify all articles pertaining to the use of SRS for the treatment of acromegaly. Surgical series describing endocrinological and radiographic outcomes were analyzed in detail and reference lists were reviewed for additional articles not identified in the original PubMed search. Pertinent clinical characteristics extracted from each report include the stereotactic radiosurgical unit; marginal radiation dose; rate of pituitary suppressive medication used during SRS; tumor size and prevalence of cavernous sinus invasion; rates of endocrinological remission and tumor growth control; and SRS-associated complications. Case series utilizing GKS, LINAC-based SRS, and CyberKnife radiosurgical systems are included in our analysis. Given a variety of confounding factors, no effort was made to directly compare the efficacies of these methods of SRS.
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