Efficacy and safety of CyberKnife radiosurgery for acromegaly

Roberts, Brian K.; Ouyang, Daniel; Lad, Shivanand P.; Chang, Steven D.; Harsh, Griffith R.; Adler, John R.; Soltys, Scott G.; Gibbs, Iris C.; Katznelson, Laurence

doi:10.1007/s11102-007-0004-3

Cited by 65 publications

(30 citation statements)

References 50 publications

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“…Hormone function improvement was documented in all seven patients with functional adenomas and this included two patients with acromegaly. Similarly, in a report of nine patients with acromegaly that were all treated with CK to doses of 18-24 Gy in one to three fractions, four patients had already achieved biochemical complete remission at a mean follow up of 25.4 months [10]. An additional patient obtained biochemical control with the addition of medical therapy.…”

Section: Stereotactic Radiosurgery For Acromegalymentioning

confidence: 82%

“…Another potential predictor of response may be radiation dose. Higher doses have been correlated with faster response [5,10]. With a mean follow up of 34 months in one study, 10 of 11 patients with acromegaly achieved normoglycemia when treated to a radiosurgery dose of >30 Gy as compared to only two of ten patients treated to lower doses [5].…”

Section: Predictors Of Radiation Responsementioning

confidence: 99%

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Radiation therapy in acromegaly

Shih

Loeffler

2007

Rev Endocr Metab Disord

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Radiation therapy is generally not a primary treatment modality for growth hormone-secreting pituitary adenomas. However, in patients with acromegaly refractory to medical and/or surgical interventions, radiation can offer durable tumor control and often biochemical remission. Technique of radiation therapy delivery and dose vary by adenoma size and extrasellar extension. Radiation can be delivered in a single sitting by stereotactic radiosurgery or in fractionated form of smaller doses delivered over typically 5-6 weeks in 25-30 treatments. A brief overview of forms of radiation modalities is reviewed followed by discussion of the role for radiation therapy, rationale of delivery method, and potential adverse effects.

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Section: Stereotactic Radiosurgery For Acromegalymentioning

confidence: 82%

Section: Predictors Of Radiation Responsementioning

confidence: 99%

Radiation therapy in acromegaly

Shih

Loeffler

2007

Rev Endocr Metab Disord

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“…For patients for whom long-term medical therapy is inappropriate or impractical, one can consider one or another form of radiation therapy. In general, for tumors that are <3 cm in diameter, focused radiosurgery with the gamma knife or the CyberKnife may be a very effective means of therapy [1,17]. For larger tumors or invasive tumors, more conventional fractionated radiation therapy which can also be carefully tailored to the anatomy of the lesion should also be considered.…”

Section: Results Of Surgical Managementmentioning

confidence: 99%

“…Ultimately, conventional radiotherapy in the form of fractionated teletherapy developed and had been applied with some success to the treatment of certain pituitary tumors including those producing growth hormone. The techniques and technology for delivering radiation therapy have improved over time as well, and currently there are many varieties of focused radiation therapy and 'radiosurgery' that are being applied to the treatment of pituitary tumors and acromegaly [1,17].…”

Section: Historical Aspectsmentioning

confidence: 99%

Surgery for acromegaly: Evolution of the techniques and outcomes

Laws

2008

Rev Endocr Metab Disord

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This paper presents an overview of the evolution of pituitary surgery for acromegaly. It begins with the first case, attempted in 1893, through the initial transsphenoidal successes in 1907-1910, to the development of effective craniotomy approaches, and ultimately to the resurrection of the transsphenoidal approach in the 1970s and thereafter. Today, the minimally endoscopic transnasal endoscopic approach is fast becoming the norm. Indications for surgery include active acromegaly, visual loss and other forms of mass effect, pituitary tumor apoplexy, and failure of other therapies (medical, radiation). Contraindications include advanced age, debility or other medical conditions increasing the risk of general anaesthesia or surgery. Surgery for acromegaly has the advantage of immediate lowering of the growth hormone excess, with endocrine remission rates of 70% for microadenomas and 50% for macroadenomas. When surgery fails to obtain remission, a program of therapy is designed for the patient to include adjunctive medical therapy (dopamine agonists, somatostatin analogs, and growth hormone receptor antagonists), radiation therapy or radiosurgery (Gamma knife, Cyberknife, etc.).

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“…41 Finally, in a small early series of frameless Cyberknife radiosurgery, 44% of patients achieved biochemical remission after a mean follow-up of 25 months. 42 …”

Section: Dosing and Efficacymentioning

confidence: 99%