PURPOSE: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. METHODS: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. RESULTS: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. CONCLUSIONS: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

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

Department of Neurological Surgery University of Pittsburgh Pittsburgh PA USA

Department of Neurosurgery University of Virginia Charlottesville VA USA

Department of Radiation Oncology Mayo Clinic Jacksonville FL USA

Department of Radiation Oncology University of Virginia Charlottesville VA USA

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

Division of Neurosurgery Centre de Recherche du CHUS University of Sherbrooke Sherbrooke QC Canada

School of Medicine National Yang Ming University Taipei Taiwan

University of Virginia Charlottesville VA USA

Zobrazit více v PubMed

J Neurooncol. 2018 Jul;138(3):519-525 PubMed

J Clin Neurosci. 2014 Jan;21(1):111-5 PubMed

Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):520-7 PubMed

Endocrinol Metab Clin North Am. 2008 Mar;37(1):101-22, viii PubMed

J Neurosurg. 2016 Jan;124(1):155-62 PubMed

J Clin Endocrinol Metab. 2014 Nov;99(11):3933-51 PubMed

World Neurosurg. 2017 Jan;97:398-406 PubMed

Expert Opin Drug Saf. 2015 Aug;14(8):1213-26 PubMed

J Neurosurg. 2006 Jan;104(1):157-62 PubMed

Endocr Pract. 2011 Jul-Aug;17 Suppl 4:1-44 PubMed

Neurosurgery. 2013 Apr;72(4):630-7; 636-7 PubMed

J Clin Endocrinol Metab. 2012 May;97(5):1589-97 PubMed

Pituitary. 2002;5(2):67-76 PubMed

Clin Endocrinol (Oxf). 1994 Jul;41(1):95-102 PubMed

Neurosurgery. 2010 Oct;67(4):949-56 PubMed

Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):112-6 PubMed

Neuro Oncol. 2015 Jan;17(1):29-44 PubMed

Pituitary. 2013 Dec;16(4):459-64 PubMed

N Engl J Med. 1996 Jan 25;334(4):246-54 PubMed

Neurosurgery. 2019 Mar 1;84(3):717-725 PubMed

Ann Intern Med. 1998 Sep 15;129(6):472-83 PubMed

J Neurooncol. 2014 May;117(3):445-57 PubMed

Neuro Oncol. 2017 Apr 1;19(suppl_2):ii38-ii49 PubMed

J Clin Endocrinol Metab. 1997 Jun;82(6):1668-74 PubMed

J Neurosurg. 2011 Feb;114(2):303-9 PubMed

J Clin Endocrinol Metab. 2014 Apr;99(4):1273-81 PubMed

J Clin Endocrinol Metab. 2010 Jul;95(7):3141-8 PubMed

Neuro Oncol. 2017 Jun 1;19(6):762-773 PubMed

J Clin Endocrinol Metab. 2000 Feb;85(2):526-9 PubMed

Endocrine. 2005 Oct;28(1):123-8 PubMed

J Neurosurg. 2012 Jan;116(1):21-32 PubMed