Gamma knife radiosurgery for acromegaly – long‐term experience

Ježková, J; Jakóbisiak, Marek; Hána, Václav; Kršek, Michal; Weiss, V; Vladyka, Vilibald; Lišák, Roman; Vymazal, Josef; Pecen, Ladislav

doi:10.1111/j.1365-2265.2006.02513.x

Cited by 155 publications

(120 citation statements)

References 58 publications

(68 reference statements)

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“…1,7,8,10,16,19,22,23,[25][26][27][28]30,33,34,[37][38][39][40][41][42]45,[47][48][49]51 The mean reported patient age was 45.2 ± 3.78 years. The overall mean duration of reported follow-up was 48.5 ± 25.8 months, and the overall median duration of reported follow-up was a similar 46.6 ± 20.4 months.…”

Section: Results Of Systematic Analysismentioning

confidence: 99%

“…If the experience from Cushing disease is any indication, in which short-term surgical remission rates of > 75% reported by many authors is contrasted by long-term data that suggests that the recurrence rate exceeds 50% short-term remission rates reported in acromegaly series must be regarded accordingly. 5,6,9,14,15,25,31,35,44 This is especially true for older series using less stringent biochemical outcome criteria. As a result, there will be a significant proportion of surgical patients who either fail to achieve remission or have disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Of these 951 patients, 472 (49.6%) achieved biochemical remission following SRS based on study-dependent endocrine criteria. 1,7,8,10,16,19,22,23,[25][26][27]30,[37][38][39][40][41][42]45,[47][48][49]51 When considering only those studies that used GH < 2.5 ng/ml or oral glucose tolerance test, GH < 1 ng/ml and normal IGF-I compared with age-and sexmatched controls as their criteria for biochemical remission, 44.5% of patients achieved disease control following SRS without medication. Utilizing a more stringent criteria of age-matched IGF-I normalization levels in series of 10 patients or more, our analysis revealed a similar 52.5% disease control rate in 506 patients with acromegaly treated using SRS.…”

Section: Analysis Of Endocrine Parameters and Srsmentioning

confidence: 99%

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A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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Object Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone–secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly. Methods A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication. Results The overall disease control rate without medication was 48%–53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 ± 25.8 months. The mean overall tumor volume in this analysis was 2.11 ± 1.16 cm3. The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546). Conclusions Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly.

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Section: Results Of Systematic Analysismentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Analysis Of Endocrine Parameters and Srsmentioning

confidence: 99%

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A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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“…This high variability can be attributed to different treatment schedules, criteria of cure or follow-up durations. GK treatment induces tumor shrinkage in about 60-75% of cases (Jezkova et al 2006, Lee et al 2014a) at 5-6 years and the percentage continues to increase slowly up to 82% at 8 years (Lee et al 2014a). The biochemical control rate is more difficult to be appreciated because various control criteria were used; a crude estimate from the largest studies published suggest biochemical control with GK in about 48% after a mean follow-up of 4 years (Newell-Price 2009).…”

Section: Medical Treatmentmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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“…With Gamma Knife radiosurgery, biochemical remission rates (without the need for medical therapy) are reported to be 10-60 % over a 5-year follow-up period. [57][58][59] It has been suggested that time to remission is shorter with Gamma Knife radiosurgery than with conventional radiotherapy, although this is not entirely clear. 57,59 Radiosurgery is generally considered if the tumor is a minimal distance from the optic chiasm resulting in an exposure of more than 800 cGy.…”

Section: Radiation Therapymentioning

confidence: 96%

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

Katznelson¹

2015

European Endocrinology

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Acromegaly is an uncommon disorder that, in the vast majority of cases, is the result of a growth hormone (GH)-secreting pituitary adenoma. Because tumors are often macroadenomas at the time of diagnosis, there may be a number of signs and symptoms related to local mass effects, including headache, visual field loss, ophthalmoplegia, and hypopituitarism. Chronic GH and insulin-like growth factor 1 (IGF-1) hypersecretion can lead to soft tissue and bone overgrowth manifestations, medical comorbidities, and accompanying clinical features. Medical comorbidites include arthropathy, cardiomegaly, type 2 diabetes, hypertension, sleep apnea syndrome, and colon polyps. In addition, acromegaly is associated with premature mortality, primarily owing to cardiovascular disease. Appropriate therapy of acromegaly can lead to improvement in these comorbidities and reversal of the premature mortality risk. This current review is an update to the 2012 summary. Diagnosis of AcromegalyThe diagnosis of acromegaly begins with a clinical suspicion by the physician that the patient has this disease. Typical physical examination findings include hand and foot enlargement or facial bone enlargement and acral/soft tissue changes. Of note, subjects usually do not present with a chief complaint related to acral growth. In women, the most common presenting complaint is amenorrhea. 2Biochemical testing involves measurement of GH and IGF-1. GH, produced by the somatotroph cells of the pituitary gland in a pulsatile fashion, circulates and stimulates hepatic secretion of IGF-1. In the recent Endocrine Society guidelines on the approach to acromegaly, it was recommended that a serum IGF-1 level be measured in subjects with acral manifestations. Owing to the lack of agreement between assays and the lack of validated normal ranges for IGF-1, 3,4 the same assay should be used in the same patient for serial measurement. 5A random GH measurement was not considered useful in diagnosis because of the lack of a well-defined normal or safe range, although a markedly elevated random GH level is certainly consistent with the disease. Additionally, in subjects with elevated or equivocal serum IGF-1 concentrations, the recent acromegaly guidelines recommended confirmation of the diagnosis with a lack of suppression of GH to less than 1 mcg/l following an oral glucose load. 6 In a patient with signs and symptoms of acromegaly and an elevated IGF-1 value, an oral glucose tolerance test (OGTT) may not be necessary for diagnosis. In the setting of a clinical suspicion but discordant values, such as an elevated IGF-1 and normal GH value (i.e., suppressible with OGTT), the subject likely has early stage acromegaly. 7After diagnosis of acromegaly, a magnetic resonance imaging (MRI) scan of the sella should be obtained to determine tumor size, location, and invasiveness. Visual field testing is performed if the tumor is touching or compressing the optic chiasm. A thorough ophthalmologic examination should be performed if the patient describes diplopia and the tumo...

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Gamma knife radiosurgery for acromegaly – long‐term experience

Abstract: In acromegaly, LGK is a useful adjunct to primary neurosurgery when treating post-surgical residues because it can limit the duration of medical therapy. It can be used as a primary therapy when neurosurgery is not possible.

Cited by 155 publications

References 58 publications

A systematic analysis of disease control in acromegaly treated with radiosurgery

A systematic analysis of disease control in acromegaly treated with radiosurgery

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

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