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

  • Clinical Study
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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.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA

    Clayton E. Alonso & James Larner

  2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Adomas Bunevicius

  3. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA

    Daniel M. Trifiletti

  4. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Cheng-Chia Lee & Fu-Yuan Pai

  5. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    Roman Liscak

  6. 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Mikulas Kosak

  7. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Hideyuki Kano, Nathaniel D. Sisterson & L. Dade Lunsford

  8. Division of Neurosurgery, Centre de Recherche du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada

    David Mathieu

  9. University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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  1. Clayton E. Alonso
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Corresponding author

Correspondence to Jason P. Sheehan.

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

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Alonso, C.E., Bunevicius, A., Trifiletti, D.M. et al. Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study. J Neurooncol 145, 301–307 (2019). https://doi.org/10.1007/s11060-019-03296-8

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  • DOI: https://doi.org/10.1007/s11060-019-03296-8

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