Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články
PubMed
31541405
DOI
10.1007/s11060-019-03296-8
PII: 10.1007/s11060-019-03296-8
Knihovny.cz E-zdroje
- Klíčová slova
- Acromegaly, Gamma Knife radiosurgery, Pituitary adenoma, Radiosurgery, Stereotactic radiosurgery,
- MeSH
- akromegalie krev radioterapie MeSH
- dospělí MeSH
- insulinu podobný růstový faktor I metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidský růstový hormon krev MeSH
- mladiství MeSH
- mladý dospělý MeSH
- radiochirurgie * MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- IGF1 protein, human MeSH Prohlížeč
- insulinu podobný růstový faktor I MeSH
- lidský růstový hormon MeSH
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
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