The role of stereotactic radiosurgery in the multimodal management of growth hormone-secreting pituitary adenomas.
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.
Stapleton
Christopher J
CJ
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Liu
Charles Y
CY
Weiss
Martin H
MH
D000172:Acromegaly / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D000236:Adenoma / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000532:radiotherapy / Q000601:surgery*; D019382:Human Growth Hormone / Q000037:antagonists & inhibitors / Q000378:metabolism; D006801:Humans; D010911:Pituitary Neoplasms / Q000097:blood / Q000532:radiotherapy / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden
D019382:Human Growth Hormone