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Stereotactic radiosurgery for acromegaly: an international systematic review and meta-analysis of clinical outcomes

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Abstract

Introduction

We performed a systematic review and meta-analysis of clinical outcomes for patients with acromegaly treated with stereotactic radiosurgery (SRS).

Methods

Primary outcomes were 5- and 10-year endocrine remission (ER) and endocrine control (EC). Secondary outcomes were 10-year radiographic local control (LC), visual toxicity, and hypopituitarism rates. Weighted random effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize and compare effect sizes. Mixed effects regression models were used to examine correlations between potential prognostic factors and primary and secondary outcomes.

Results

In total, 1533 patients across 20 published studies with acromegaly treated with SRS were included. At 5-years, estimated ER and EC rates were 43.2% (95% CI 31.7–54.6%) and 55.0% (95% CI 27.6–82.4%), respectively. At 10-years, estimated ER and EC rates were 56.9% (95% CI 47.5–66.4%) and 69.7% (95% CI 47.7–91.8%), respectively. The estimated 10-year LC rate was 92.8% (95% CI 83.0–100%). Visual toxicity and hypopituitarism following SRS were estimated to be 2.7% (95% CI 1.3–4.2%) and 26.8% (95% CI 16.9–36.7%), respectively. Every 1 Gy increase in margin prescription dose beyond 17 Gy was estimated to result in a 0.41% increased risk of visual toxicity (p = 0.03). No prognostic factors were associated with EC, ER, LC, or hypopituitarism.

Conclusions

SRS was well-tolerated in the management of pituitary acromegaly resulting in gradually improving ER and EC rates over time that approached 60% and 70%. SRS-related visual loss is an uncommon treatment-related side effect, and patient-specific clinical decision making remains critical.

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Funding

This work was partially supported by the Eveleigh Family Career Development Award for Cancer Research at Mayo Clinic in Florida.

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Authors and Affiliations

  1. Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA, USA

    Raj Singh

  2. Rady School of Management, University of California at San Diego, San Diego, CA, USA

    Prabhanjan Didwania

  3. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Eric J. Lehrer

  4. Department of Neurosurgery, University of Virginia, School of Medicine, Box 800212, Charlottesville, VA, 22903, USA

    Darrah Sheehan, Kimball Sheehan & Jason P. Sheehan

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

    Daniel M. Trifiletti

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Correspondence to Jason P. Sheehan.

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The procedures followed for the purposes of this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) or with the Helsinki Declaration (1964, amended in 1975, 1983, 1989, 1996 and 2000) of the World Medical Association.

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Supplementary Figure 4—Meta-regression results examining correlation between margin prescription dose and visual toxicity rate (DOCX 110 kb)

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Singh, R., Didwania, P., Lehrer, E.J. et al. Stereotactic radiosurgery for acromegaly: an international systematic review and meta-analysis of clinical outcomes. J Neurooncol 148, 401–418 (2020). https://doi.org/10.1007/s11060-020-03552-2

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