BACKGROUND: Stereotactic radiosurgery (SRS) is a treatment option for persistent or recurrent acromegaly secondary to a growth hormone secreting pituitary adenoma, but its efficacy is inadequately defined. OBJECTIVE: To assess, in a multicenter, retrospective cohort study, the outcomes of SRS for acromegaly and determine predictors. METHODS: We pooled and analyzed data from 10 participating institutions of the International Gamma Knife Research Foundation for patients with acromegaly who underwent SRS with endocrine follow-up of ≥6 mo. RESULTS: The study cohort comprised 371 patients with a mean endocrine follow-up of 79 mo. IGF-1 lowering medications were held in 56% of patients who were on pre-SRS medical therapy. The mean SRS treatment volume and margin dose were 3.0 cm3 and 24.2 Gy, respectively. The actuarial rates of initial and durable endocrine remission at 10 yr were 69% and 59%, respectively. The mean time to durable remission after SRS was 38 mo. Biochemical relapse after initial remission occurred in 9%, with a mean time to recurrence of 17 mo. Cessation of IGF-1 lowering medication prior to SRS was the only independent predictor of durable remission (P = .01). Adverse radiation effects included the development of ≥1 new endocrinopathy in 26% and ≥1 cranial neuropathy in 4%. CONCLUSION: SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.

3rd Department of Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania

Department of Neurosurgery Barrow Neurological Institute Phoenix Arizona

Department of Neurosurgery MD Anderson Cancer Center Houston Texas

Department of Neurosurgery New York University Langone Medical Center New York New York

Department of Neurosurgery Ruber Internacional Hospital Madrid Spain

Department of Neurosurgery Taipei Veterans General Hospital Taipei Taiwan

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania USA

Department of Neurosurgery University of Virginia Charlottesville Virginia

Department of Neurosurgery University of Virginia Charlottesville Virginia Department of Medicine University of Virginia Charlottesville Virginia

Department of Neurosurgery West Virginia University Morgantown West Virginia

Department of Radiation Oncology Beaumont Health System Royal Oak Michigan

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

Division of Neurosurgery Centre de recherche du CHUS University of Sherbrooke Sherbrooke Quebec Canada

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$a BACKGROUND: Stereotactic radiosurgery (SRS) is a treatment option for persistent or recurrent acromegaly secondary to a growth hormone secreting pituitary adenoma, but its efficacy is inadequately defined. OBJECTIVE: To assess, in a multicenter, retrospective cohort study, the outcomes of SRS for acromegaly and determine predictors. METHODS: We pooled and analyzed data from 10 participating institutions of the International Gamma Knife Research Foundation for patients with acromegaly who underwent SRS with endocrine follow-up of ≥6 mo. RESULTS: The study cohort comprised 371 patients with a mean endocrine follow-up of 79 mo. IGF-1 lowering medications were held in 56% of patients who were on pre-SRS medical therapy. The mean SRS treatment volume and margin dose were 3.0 cm3 and 24.2 Gy, respectively. The actuarial rates of initial and durable endocrine remission at 10 yr were 69% and 59%, respectively. The mean time to durable remission after SRS was 38 mo. Biochemical relapse after initial remission occurred in 9%, with a mean time to recurrence of 17 mo. Cessation of IGF-1 lowering medication prior to SRS was the only independent predictor of durable remission (P = .01). Adverse radiation effects included the development of ≥1 new endocrinopathy in 26% and ≥1 cranial neuropathy in 4%. CONCLUSION: SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.

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$a Mehta, Gautam U $u Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas.

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$a Lee, Cheng-Chia $u Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.

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$a Liscak, Roman $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.

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$a Kano, Hideyuki $u Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

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$a Pai, Fu-Yuan $u Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.

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$a Kosak, Mikulas $u 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.

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$a Vance, Mary Lee $u Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. Department of Medicine, University of Virginia, Charlottesville, Virginia.

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