title: Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion.
abstract: BACKGROUND
  Because surgical and medical therapies of acromegaly all have specific limitations, radiotherapy has been used as an adjunctive strategy. Stereotactic radiosurgery has not yet been widely evaluated.
  
  
  OBJECTIVE
  The objective was to perform an analysis of long-term hormonal effects and tolerance of gamma knife radiosurgery.
  
  
  METHODS
  Eighty-two patients were prospectively studied over a decade, with a mean follow-up of 49.5 months.
  
  
  METHODS
  All patients were treated at the Department of Functional Neurosurgery of Marseille, France.
  
  
  METHODS
  The patients included 82 with active acromegaly, of whom 63 had previous transsphenoidal surgery.
  
  
  METHODS
  Intervention included radiosurgery using the Leksell Gamma Unit B model.
  
  
  METHODS
  Remission was diagnosed when mean GH levels were less than 2 ng/ml and IGF-I was normal for age off somatostatin agonists (at least 3 months).
  
  
  RESULTS
  Seventeen percent of the patients were in remission without any treatment. Twenty-three percent previously uncontrolled on somatostatin agonists fulfilled the same criteria after gamma knife while maintained on medical treatment. Initial GH and IGF-I levels off somatostatin agonists were significantly higher in uncured than in remission group (P = 0.01 and 0.047, respectively). Withdrawal of somatostatin agonists at the time of radiosurgery had no incidence on the outcome. No significant difference was found in success rate whether patients had previously been treated or not. Long-term side effects included complete (n = 2) or partial (n = 12) hypopituitarism diagnosed 1-7 yr after gamma knife.
  
  
  CONCLUSIONS
  Gamma knife radiosurgery may represent a therapeutic approach in patients with moderate initial or residual GH hypersecretion.
authors.affiliation: Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, Marseille, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Castinetti
authors.forename: David
authors.initials: D
authors.lastname: Taieb
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Kuhn
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
authors.forename: Manabu
authors.initials: M
authors.lastname: Tamura
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaquet
authors.forename: Bernard
authors.initials: B
authors.lastname: Conte-Devolx
authors.forename: Jean
authors.initials: J
authors.lastname: Régis
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
mesh_terms: D000172:Acromegaly / Q000601:surgery*; D000236:Adenoma / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone