OBJECTIVE: The role of primary stereotactic radiosurgery (SRS) in patients with medically refractory acromegaly who are not operative candidates or who refuse resection is poorly understood. The aim of this multicenter, matched cohort study was to compare the outcomes of primary versus postoperative SRS for acromegaly. METHODS: The authors reviewed an International Radiosurgery Research Foundation database of 398 patients with acromegaly who underwent SRS and categorized them into primary or postoperative cohorts. Patients in the primary SRS cohort were matched, in a 1:2 ratio, to those in the postoperative SRS cohort, and the outcomes of the 2 matched cohorts were compared. RESULTS: The study cohort comprised 78 patients (median follow-up 66.4 months), including 26 and 52 in the matched primary and postoperative SRS cohorts, respectively. In the primary SRS cohort, the actuarial endocrine remission rates at 2 and 5 years were 20% and 42%, respectively. The Cox proportional hazards model showed that a lower pre-SRS insulin-like growth factor-1 level was predictive of initial endocrine remission (p = 0.03), whereas a lower SRS margin dose was predictive of biochemical recurrence after initial remission (p = 0.01). There were no differences in the rates of radiological tumor control (p = 0.34), initial endocrine remission (p = 0.23), biochemical recurrence after initial remission (p = 0.33), recurrence-free survival (p = 0.32), or hypopituitarism (p = 0.67) between the 2 matched cohorts. CONCLUSIONS: Primary SRS has a reasonable benefit-to-risk profile for patients with acromegaly in whom resection is not possible, and it has similar outcomes to endocrinologically comparable patients who undergo postoperative SRS. SRS with medical therapy in the latent period can be used as an alternative to surgery in selected patients who cannot or do not wish to undergo resection.

73rd Department of Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Neurological Surgery Centre de Recherche du CHUS Sherbrooke Quebec Canada; and

Department of Neurological Surgery University of Pittsburgh Pennsylvania

Department of Neurological Surgery University of Virginia Health System Charlottesville Virginia

Department of Neurological Surgery West Virginia University Morgantown West Virginia

Department of Neurosurgery Ruber Internacional Hospital Madrid Spain

Department of Neurosurgery Taipei Veterans General Hospital Taipei Taiwan

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Alexopoulou O, Bex M, Abs R, T’Sjoen G, Velkeniers B, Maiter D: Divergence between growth hormone and insulin-like growth factor-I concentrations in the follow-up of acromegaly. J Clin Endocrinol Metab 93:1324–1330, 2008 PubMed

Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, et al.: Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study. J Clin Endocrinol Metab 88:3105–3112, 2003 PubMed

Austin PC: An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424, 2011 PubMed PMC

Castinetti F, Taieb D, Kuhn JM, Chanson P, Tamura M, Jaquet P, et al.: Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab 90:4483–4488, 2005 PubMed

Didoni G, Grottol S, Gasco V, Battistini M, Ferone D, Giusti M, et al.: Cost-of-illness study in acromegalic patients in Italy. J Endocrinol Invest 27:1034–1039, 2004 PubMed

Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, et al.: Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study. Neurosurgery 84:717–725, 2019 PubMed PMC

Freda PU, Post KD, Powell JS, Wardlaw SL: Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 83:3808–3816, 1998 PubMed

Holdaway IM, Rajasoorya RC, Gamble GD: Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89:667–674, 2004 PubMed

Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, et al.: Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951, 2014 PubMed

Kim SH, Huh R, Chang JW, Park YG, Chung SS: Gamma Knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg 72 (Suppl 1):101–110, 1999 PubMed

Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, et al.: Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 85:1287–1289, 2000 PubMed

Laws ER, Sheehan JP, Sheehan JM, Jagnathan J, Jane JA Jr, Oskouian R: Stereotactic radiosurgery for pituitary adenomas: a review of the literature. J Neurooncol 69:257–272, 2004 PubMed

Lunt M: Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching. Am J Epidemiol 179:226–235, 2014 PubMed PMC

Moore DJ, Adi Y, Connock MJ, Bayliss S: Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation. BMC Endocr Disord 9:20, 2009 PubMed PMC

Pollock BE, Jacob JT, Brown PD, Nippoldt TB: Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg 106:833–838, 2007 PubMed

Pomeraniec IJ, Kano H, Xu Z, Nguyen B, Siddiqui ZA, Silva D, et al.: Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. J Neurosurg 129:648–657, 2018 PubMed PMC

Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML: Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 114:303–309, 2011 PubMed

Snell JW, Sheehan J, Stroila M, Steiner L: Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg 104:157–162, 2006 PubMed

Thorén M, Rähn T, Guo WY, Werner S: Stereotactic radiosurgery with the cobalt-60 gamma unit in the treatment of growth hormone-producing pituitary tumors. Neurosurgery 29:663–668, 1991 PubMed

Zhang N, Pan L, Wang EM, Dai JZ, Wang BJ, Cai PW: Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg 93 (Suppl 3):6–9, 2000 PubMed

A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas