title: Long-term results of fractionated stereotactic radiotherapy as third-line treatment in acromegaly.
abstract: The treatment of acromegaly is based on surgery, drugs, and radiotherapy as a third-line option. Fractionated stereotactic radiotherapy (FSRT) is a new technique with a need for long-term evaluation. The purpose of the study was to evaluate long-term results of FSRT in acromegaly. Overall, 34 patients [sex ratio 1.12, age 45 (5-65) years] with a pituitary adenoma of 24.5 (9-76) mm including 20 invasive tumors were treated by radiotherapy in fractionated stereotactic conditions delivering 50 gy in 27 sessions. Baseline growth hormone (GH) and IGF1 levels were 18 (±14.5) and 632.6 (±339) µg/L, respectively. Indications of FSRT were failure of surgery and drug treatments (n = 30) or contraindication/refusal of surgery (n = 4). Hormonal control was defined by normal age- and sex-adjusted IGF1. Remission was defined by hormonal control after withdrawal of drugs for a minimum of three consecutive months. Data were analyzed in SPSS software with a significance level at p < 0.05. After a mean follow-up of 152 months, hormonal control was achieved in 33 patients (97 %) with withdrawal of drugs in 13 patients (38.2 %) without any recurrence. Factors found to be significantly associated to remission in a multivariate Cox regression were lower baseline hormone levels (GH and IGF1) and smaller tumor size. Tumor control was achieved in all patients. Acquired hypopituitarism after radiotherapy was the main side effect reported with a rate of 39 %. FSRT seems to be an effective and well tolerated third-line treatment of acromegaly, particularly adapted to macro adenomas treatment.
authors.affiliation: Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Reims, 51092, Reims, France.
authors.forename: Alpha M
authors.initials: AM
authors.lastname: Diallo
authors.affiliation: Center of Radiotherapy, Institute of Cancer Courlancy Reims, 51100, Reims, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Colin
authors.affiliation: Department of Neurosurgery, University Hospital of Reims, 51092, Reims, France.
authors.forename: Claude F
authors.initials: CF
authors.lastname: Litre
authors.affiliation: Depatment of Endocrinology and Metabolism, University Hospital of Donka, Conakry, Guinea.
authors.forename: Mamadou M
authors.initials: MM
authors.lastname: Diallo
authors.affiliation: Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Reims, 51092, Reims, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Decoudier
authors.affiliation: Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Reims, 51092, Reims, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bertoin
authors.affiliation: Department of Radiology, University Hospital of Reims, 51092, Reims, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Higel
authors.affiliation: Department of Anatomy and Pathology, University Hospital of Reims, 51092, Reims, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Patey
authors.affiliation: Department of Neurosurgery, University Hospital of Reims, 51092, Reims, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousseaux
authors.affiliation: Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Reims, 51092, Reims, France. bdelemer@chu-reims.fr.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delemer
mesh_terms: D000236:Adenoma / Q000097:blood / Q000532:radiotherapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000097:blood; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000532:radiotherapy*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D016879:Salvage Therapy; D013238:Stereotaxic Techniques; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C583557:IGF1 protein, human; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone
keywords: Acromegaly; Fractionated stereotactic radiotherapy; Long-term results