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Assessment of multimodal treatment options in recurrent and persistent acromegaly: a systematic review and meta-analysis

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Abstract

Purpose

In patients with acromegaly, secondary treatment options in cases of hormonal non-remission or tumor progression include repeat transsphenoidal surgery (TSS), radiation-based treatment (RT), or medical therapy (MT). In this study, we aim to evaluate the clinical effectiveness of various second-line treatment options for acromegaly.

Methods

Using the PRISMA guideline, a systematic review was performed by searching MEDLINE (PubMed), Web of Science, Scopus, and Cochrane electronic bibliographic databases from conception to the end of 2022. Outcomes of interest included hormonal remission rate, complications, and mortality associated with each treatment modality for refractory acromegaly.

Results

A total of 79 studies including 3,208 refractory acromegaly patients (44.90% males) were analyzed, with a mean patient age of 43.89 years. There was a statistically significant difference between various therapeutic modalities in terms of remission rate, with MT offering the highest remission rate (62.55%), followed by RT (50.15%) and TSS (37.39%). Subgroup analysis of radiotherapeutic and medical modalities did not show a significant difference in remission rate between different kinds of sub-modalities in each treatment approach. Recurrence following secondary treatment was not different in patients treated with reoperation TSS compared to other modalities.

Conclusions

The management of persistent and recurrent acromegaly optimally requires a multimodal approach. In different scenarios of refractory acromegaly based on previous treatment, secondary treatments may vary in terms of remission rate and complications. Medical agents provide considerable effectiveness as a second-line therapy for recurrent or persistent disease. In selected cases, however, reoperation still provides an opportunity for cure or freedom from medications. The findings of this study may help clinicians to prioritize varying options involved in this multifaceted decision-making process.

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Data availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Neurosurgery Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Seyed Farzad Maroufi & Fatemeh Mahdavi Sabet

  2. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Farzad Maroufi

  3. Department of Surgery, University of Florida, Jacksonville, FL, USA

    Manijeh Assar

  4. Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York City, NY, USA

    MirHojjat Khorasanizadeh

  5. Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, FL, USA

    Mohammadmahdi Sabahi, Rocco Dabecco, Badih Adada & Hamid Borghei-Razavi

  6. Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Gabriel Zada

  7. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 2950 Cleveland Clinic Blvd., 33331, Weston, FL, USA

    Hamid Borghei-Razavi

Authors
  1. Seyed Farzad Maroufi
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Contributions

SFM, MA, FMS: Data gathering; SFM, MK, MMS: Writing the primary draft; SFM: Statistical analysis; RD, BA, GZ, HBR: Critically revising the draft; SFM, BA, GZ, HBR: Study design and conceptualization; HBR: Supervision; All authors approved the final manuscript.

Corresponding author

Correspondence to Hamid Borghei-Razavi.

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Maroufi, S.F., Assar, M., Khorasanizadeh, M. et al. Assessment of multimodal treatment options in recurrent and persistent acromegaly: a systematic review and meta-analysis. J Neurooncol 168, 13–25 (2024). https://doi.org/10.1007/s11060-024-04658-7

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  • DOI: https://doi.org/10.1007/s11060-024-04658-7

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