Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial.
OBJECTIVE
To investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas.


METHODS
A prospective, randomised study.


METHODS
After a baseline evaluation, patients were randomly assigned to 4-month preoperative treatment with lanreotide (starting with 30 mg/2 weeks i.m. and increasing to 30 mg/week i.m. at week 8 if mean GH >2.5 microg/l on GH day curves; pretreatment group, Group 1) or to transsphenoidal surgery (direct surgery group, Group 2). Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal.


RESULTS
A pool of 108 patients was randomly divided into two groups. Five patients in each group were lost to follow-up during the study period, so 49 patients in each group were analysed. At baseline, no difference was observed between the two groups. Cure was established in 24 of 49 (49.0%, 95% confidence interval (CI), 35.0-63.0%) pretreated patients (Group 1) versus 9 of 49 (18.4%, 95% CI, 7.6-29.2%) direct surgery patients (Group 2; P=0.001). Surgical morbidity was recorded in 12 patients (12.2%) and was similar in Group 1 and 2 patients (14.3 and 10.2% respectively; P=0.538). The postoperative hospital stay was similar between groups: being 4.5+/-1.6 days in Group 1 vs 4.8+/-1.9 days in Group 2 (P=0.328).


CONCLUSIONS
Pretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas. Pretreatment does not affect surgical complications or duration of hospital stay (ClinicalTrials.gov number, NCT00993356).
Mao
Zhi-gang
ZG
Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan Er Road, Guangzhou 510080, People's Republic of China.
Zhu
Yong-hong
YH
Tang
Hai-liang
HL
Wang
Dao-yuan
DY
Zhou
Jing
J
He
Dong-sheng
DS
Lan
Hai
H
Luo
Bai-ning
BN
Wang
Hai-jun
HJ
D000172:Acromegaly / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D000236:Adenoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000970:Antineoplastic Agents; D010456:Peptides, Cyclic; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I