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


METHODS
The study was a retrospective analysis of hormonal, radiological, and ophthalmologic data collected in a predefined protocol from 1994 through 2006.


METHODS
The study was performed at a university hospital.


METHODS
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).


METHODS
The patients were treated with SR for residual or recurrent GH-secreting adenoma.


METHODS
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.


CONCLUSIONS
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.
Losa
Marco
M
Department of Neurosurgery, Istituto Scientifico San Raffaele, Via Olgettina 60, Milan, Italy. losa.marco@hsr.it
Gioia
Lorenzo
L
Picozzi
Piero
P
Franzin
Alberto
A
Valle
Micol
M
Giovanelli
Massimo
M
Mortini
Pietro
P
D000236:Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000328:Adult; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I