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Journal of Neuro-Oncology

, Volume 145, Issue 2, pp 301–307 | Cite as

Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study

  • Clayton E. Alonso
  • Adomas Bunevicius
  • Daniel M. Trifiletti
  • James Larner
  • Cheng-Chia Lee
  • Fu-Yuan Pai
  • Roman Liscak
  • Mikulas Kosak
  • Hideyuki Kano
  • Nathaniel D. Sisterson
  • David Mathieu
  • L. Dade Lunsford
  • Jason P. SheehanEmail author
Clinical Study

Abstract

Purpose

Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly.

Methods

Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy.

Results

Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit.

Conclusions

Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

Keywords

Gamma Knife radiosurgery Acromegaly Radiosurgery Stereotactic radiosurgery Pituitary adenoma 

Notes

Compliance with ethical standards

Conflict of interest

L.D.L. reports stock ownership in Elekta AB.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Clayton E. Alonso
    • 1
  • Adomas Bunevicius
    • 2
  • Daniel M. Trifiletti
    • 3
  • James Larner
    • 1
  • Cheng-Chia Lee
    • 4
  • Fu-Yuan Pai
    • 4
  • Roman Liscak
    • 5
  • Mikulas Kosak
    • 6
  • Hideyuki Kano
    • 7
  • Nathaniel D. Sisterson
    • 7
  • David Mathieu
    • 8
  • L. Dade Lunsford
    • 7
  • Jason P. Sheehan
    • 9
    Email author
  1. 1.Department of Radiation OncologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of NeurosurgeryUniversity of VirginiaCharlottesvilleUSA
  3. 3.Department of Radiation OncologyMayo ClinicJacksonvilleUSA
  4. 4.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  5. 5.Department of Stereotactic and Radiation NeurosurgeryNa Homolce HospitalPragueCzech Republic
  6. 6.3rd Department of Medicine, First Faculty of MedicineCharles UniversityPragueCzech Republic
  7. 7.Department of Neurological SurgeryUniversity of PittsburghPittsburghUSA
  8. 8.Division of Neurosurgery, Centre de Recherche du CHUSUniversity of SherbrookeSherbrookeCanada
  9. 9.University of VirginiaCharlottesvilleUSA

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