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Whole Sella vs Targeted Stereotactic Radiosurgery for Acromegaly: A Multicenter Matched Cohort Study

DG. Taylor, A. Janssen, D. Ding, Z. Xu, GU. Mehta, R. Liscak, H. Kano, M. Kosak, N. Martinez-Moreno, L. Hobbs, CJ. Chen, IS. Grills, D. Mathieu, LD. Lunsford, ML. Vance, JP. Sheehan,

. 2020 ; 86 (5) : 656-664. [pub] 20200501

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc20028221
E-resources Online Full text

NLK ProQuest Central from 2010-01-01 to 2021-12-31
Health & Medicine (ProQuest) from 2010-01-01 to 2021-12-31

Links

PubMed 31384920
DOI 10.1093/neuros/nyz245
Knihovny.cz E-resources

BACKGROUND: Targeted stereotactic radiosurgery (SRS) with sparing of the residual pituitary is the traditional radiosurgical method for pituitary adenomas. Whole-sella SRS is an alternative choice for radiologically indeterminate or large adenomas, the safety and efficacy of which has yet to be determined. OBJECTIVE: To determine if whole-sella SRS in acromegaly would have comparable radiographic and biochemical control to targeted SRS. We performed a multicenter, retrospective matched cohort study to compare outcomes between groups. METHODS: We conducted a retrospective review of acromegalic patients who underwent SRS from 1990 to 2016 at 10 centers participating in the International Radiosurgery Research Foundation. Whole-sella and targeted SRS patients were then matched in a 1:1 ratio. RESULTS: A total of 128 patients were eligible for inclusion. Whole-sella patients had a higher pre-SRS random serum growth hormone, larger treatment volume, and higher maximum point dose to the optic apparatus. The rates of initial/durable endocrine remission, new loss of pituitary function, and new cranial neuropathy were similar between groups. Mortality and new visual deficit were higher in the whole-sella cohort, though not statistically significant. CONCLUSION: There was no difference in biochemical remission or recurrence between treatment groups. Although not statistically significant, the higher rates of tumor regression and lower rates of mortality and new visual deficit may suggest consideration of targeted SRS over whole-sella SRS in acromegaly treatment. Further research is needed to determine the association between visual deficits and mortality with whole-sella SRS.

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$a Janssen, Andrew $u Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
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$a Kosak, Mikulas $u First Faculty of Medicine, 3rd Department of Medicine, Charles University, Prague, Czech Republic.
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