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Role of biological effective dose for prediction of endocrine remission in acromegaly patients treated with stereotactic radiosurgery

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Abstract

Purpose

Stereotactic radiosurgery (SRS) can be used in acromegaly patients to achieve endocrine remission. In this study we evaluate the biological effective dose (BED) as a predictor of SRS outcomes for acromegaly.

Method

This retrospective, single-center study included patients treated with single-fraction SRS with growth hormone secreting pituitary adenomas and available endocrine follow-up. Kaplan–Meier analysis was used to study endocrine remission, new pituitary deficit, and tumor control. Cox analyses were performed using two models [margin dose (model 2) versus BED (model 1)].

Results

Sixty-seven patients (53.7% male) with a median age of 46.8 years (IQR 21.2) were treated using a median dose of 25 Gy (IQR 5), and a median BED of 171.9Gy2.47 (IQR 66.0). Five (7.5%) were treated without stopping antisecretory medication. The cumulative probability of maintained endocrine remission off suppressive medications was 62.5% [47.9–73.0] at 3 years and 76.5% [61.0–85.9] at 5 years. IGF1i > 1.5 was a predictor of treatment failure [Hazard ratio (HR) 0.40 (0.21–0.79) in model 1, p = 0.00783]. Margin dose > 22 Gy [HR 2.33 (1.06–5.13), p = 0.03593] or a BED > 170Gy2.47 [HR 2.02 (1.06–3.86), p = 0.03370] were associated with endocrine remission. The cumulative probability of new hypopituitarism after SRS was 36.8% (CI 95% 22.4–45.9) at 3 years and 53.2% (CI 95% 35.6–66) at 5 years. BED or margin dose were not associated with new hypopituitarism.

Conclusion

BED is a strong predictor of endocrine remission in patients treated with SRS. Dose planning and optimization of the BED to > 170Gy2.47 give a greater probability of endocrine remission in acromegalic patients.

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Data availability

The data can be available upon reasonable request to the corresponding author.

Abbreviations

BED:

Biological effective dose

HR:

Hazard ratio

IGF1i :

Insulin growth factor index

IQR:

Interquartile range

Gy:

Gray

OGT:

Oral glucose test

SRS:

Stereotactic radiosurgery

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Acknowledgements

Dr Dumot gratefully acknowledges receipt of a grant for mobility from the Hospices civils de Lyon, France, from the Institut Servier, France, from the Societe française of Neurochirurgie (SFNC), France, from the Fondation Planiol, France, from the Phillip foundation.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia, Charlottesville, VG, USA

    Chloe Dumot, David Schlesinger, Georgios Mantziaris, Sam Dayawansa, Zhiyuan Xu & Jason P. Sheehan

  2. Department of neurological surgery, Hospices civils de Lyon, Lyon, France

    Chloe Dumot

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Contributions

Conception and design: JPS, DS. Acquisition of data: CD, DS. Analysis and interpretation of data: CD, DS, GM. Drafting the article: CD, GM. Critically revising the article: JPS, DS, GM, SD. ZX, Reviewed submitted version of manuscript: all authors. Statistical analysis: CD, DS, GM. Study supervision: JPS.

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Correspondence to Jason P. Sheehan.

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Dumot, C., Schlesinger, D., Mantziaris, G. et al. Role of biological effective dose for prediction of endocrine remission in acromegaly patients treated with stereotactic radiosurgery. Pituitary 26, 124–131 (2023). https://doi.org/10.1007/s11102-022-01293-1

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