, Volume 16, Issue 1, pp 115-121
Date: 06 Apr 2012

Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA)

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Abstract

Since 1997 there is an online National Registry of acromegalic patients in Spain (REA). We aimed to study changes in acromegaly treatment and outcomes over the last four decades in Spain. In REA clinical and biochemical data are collected at diagnosis and updated every one to 2 years. We analyzed the first treatment received and the different treatments administered according to decade of diagnosis of acromegaly: prior to 1980, 1980–1989, 1990–1999 and 2000–2009. Surgical cure rates according to pretreatment with long-acting somatostatin receptor ligands (SRLs) were also analyzed. 1,658 patients were included of which 698 had accurate follow-up data. Treatment of acromegaly changed over time. Surgery was the main treatment option (83.8 %) and medical treatment was widely used (74.7 %) both maintained over decades, while radiation therapy declined (62.8, 61.6, 42.2 and 11.9 % over decades, p < 0.001). First treatment type also changed: surgery was the first line option up until the last decade in which medical treatment was preferred (p < 0.001). Radiotherapy was barely used as first treatment. Treatment combinations changed over time (p < 0.001). The most common treatment combination (surgery plus medical therapy), was received by 24.4, 16.4, 25.3 and 56.5 % of patients over decades. Medical treatment alone was performed in 7.3, 6, 7.2 and 14.7 % over decades. Type of medical treatment also changed, SRLs becoming the first medical treatment modality in the last decades, whereas dopamine agonist use declined (p < 0.001). Surgical cure rates improved over decades (21, 21, 36 and 38 %, p = 0.002) and were not influenced by SRL pre-surgical use. Acromegaly treatment has changed in Spain in the last four decades. Surgery has been the main treatment option for decades; however, medical therapy has replaced surgery as first line in the last decade and radiotherapy rates have clearly declined. SRLs are the most used medical treatment.

Dr. Varela recently passed away.
List of REA investigators in alphabetical order: Victoria Alcázar Lázaro, Hospital Severo Ochoa, Madrid, Javier Aller Pardo, Hospital Puerta de Hierro, Madrid, Cristina Álvarez Escolà, Hospital Universitario la Paz, Madrid, Paula Álvarez Vazquez, Complejo Hospitalario de Ourense, Orense, Ignacio Bernabeu Morón, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Carmen Bernal González, Hospital 12 de Octubre, Madrid, Concepción Blanco Carrera, Hospital Principe de Asturias, Madrid, Alejandro Cámara Balda, Hospital San Pedro, Logroño, Rosa Cámara Gómez, Hospital La Fe, Valencia, Emilia Cáncer Minchot, Hospital de Fuenlabrada, Madrid, Ignasi Castells Fust, Hospital de Granollers, Barcelona, Carlos Del Pozo Picó, Hospital Mutua de Terrassa, Terrassa, Juan José Díez Gómez, Hospital Universitario la Paz, Madrid, Alberto Díez Hernández, Hospital del Bierzo, Ponferrada, León, Carmen Fajardo Montañana, Hospital de la Ribera, Alzira, Lluis Forga Llenas, Hospital de Navarra, Navarra, Rogelio García Centeno, Hospital Gregorio Marañón, Madrid, Honorato García Fernández, Hospital Son Dureta, Mallorca, Manuel Gargallo Fernandez, Hospital Virgen de la Torre, Madrid, Sonia Gaztambide Sáenz, Hospital de Cruces, Barakaldo, Irene Halperin Rabinovich, Hospital Clínic, Barcelona, Juan Angel Hernández Bayo, Hospital de la Palma, Tenerife, Miguel Angel Jaunsolo Barranechea, Hospital Severo Ochoa, Madrid, Manuel Luque Ramírez, Hospital de la Princesa, Madrid, Camelia Martí Ippoliti, Hospital de Sant Pau, Barcelona, Miguel Ángel Martínez Olmos, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Francisca Mas, Hospital de Manacor, Mallorca, Alberto Moreno Carazo, Complejo Hospitalario de Jaen, Jaén, Basilio Moreno Esteban, Hospital Gregorio Marañón, Madrid, Jesus Moreno Fernandez, La Mancha Centro Endocrinología y Nutrición Ciudad Real, Gabriel Obiols Alfonso, Hospital Vall d’Hebrón, Barcelona, Herminia Pascual Saura, Hospital Morales Meseguer, Murcia, Antonio Pico Alfonso, Hospital General Universitario, Alicante, Elena Riquelme, Centro médico intergral de Henares, Madrid Mª Pilar Ruiz-Valdepeñas Herrero, Hospital 12 de Octubre, Madrid, Isabel Salinas i Vert, Hospital Germans Trias i Pujol, Barcelona, MªConcepción Sanabria Pérez, Complejo Hospitalario Ciudad Real, Ciudad Real, Piedad Santiago Fernández, Hospital General de Jaén, Jaén, Alicia Serraclara Pla, Hospital 12 de Octubre, Madrid, Gemma Sesmilo León, Institut Universitari Dexeus, Barcelona, Alfonso Soto Moreno, Hospital Universitario Virgen del Rocío, Sevilla, Elena Torres Vela, Hospital Universitario San Cecilio, Granada, César Varela, Hospital Infanta Sofía, Madrid, Eva Venegas Moreno, Hospital Universitario Virgen del Rocío, Sevilla, Almudena Vicente Delgado, Hospital Virgen de la Salud, Toledo, Carles Villabona Artero, Hospital de Bellvitge, Barcelona, Susan M Webb, Hospital de Sant Pau, Barcelona.