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 μg/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 analysisshowedthat low basal GH and IGF-I levels were associated with a favorable outcome. Noserious 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.
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism