Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study

Ding, Dale; Mehta, Gautam U.; Patibandla, Mohana Rao; Lee, Cheng‐Chia; Liščák, Roman; Kano, Hideyuki; Pai, Fu-Yuan; Kosák, Mikuláš; Sisterson, Nathaniel D; Martínez‐Álvarez, Roberto; Martínez-Moreno, Nuria; Mathieu, David; Grills, I.S.; Blas, Kevin; Lee, Kuei; Cifarelli, Christopher P.; Katsevman, Gennadiy A.; Lee, John Y.K.; McShane, Brendan; Kondziolka, Douglas; Lunsford, L. Dade; Vance, Mary Lee; Sheehan, Jason P.

doi:10.1093/neuros/nyy178

Cited by 66 publications

(45 citation statements)

References 31 publications

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“…Moreover, in another large cohort of 371 patients treated by stereotactic radiosurgery, the actual rates of initial and durable endocrine remission at 10 years were 69 and 59%, respectively. Interestingly, cessation of IGF-I-lowering medication prior to stereotactic radiosurgery was the only independent predictor of durable remission (65).…”

Section: Radiation Therapymentioning

confidence: 96%

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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Acromegaly is a rare and challenging disease calling for management in highly specialised multidisciplinary teams (MDTs). Untreated disease has severe morbidity and a clearly increased mortality. Major attainments have been gained over the latest decades, and therefore, the aim of this review is to discuss recent achievements in modern multimodal therapy of acromegaly performed by MDTs, with an emphasis on an individualised, proactive management from the time of diagnosis to long-term outcome. Treatment by surgery is the only potential curative treatment, however, even with modern techniques still with modest cure rates, leaving the patients to often long-term medical treatment. Treatment strategies have changed dramatically in the Western world over recent years, implying a more proactive treatment algorithm often with a shorter or longer pre-surgical treatment period with somatostatin receptor ligands (SRLs). Not all patients will however respond to primary treatment with conventional SRLs and there has recently been a development of potential biomarkers for response that has been implemented in the clinical routine. By today, multimodal treatment can bring every patient in remission, but still almost a third of all patients are undertreated according to large, international registries. On the other hand, it might be a challenge not to over treat thereby bringing the patient into a state of relative or absolute growth hormone deficiency. Clinical series published during the last decade on treatment of patients with acromegaly have indicated a normalisation of mortality, most probably reflecting the proactive and individualised modern treatment. In conclusion, modern, multimodal treatment seems to have normalised mortality, but still the patients suffer from a high multi-organ morbidity and often multipharmacy. Every patient should receive an individualised, proactive treatment in order to improve long-term outcome and to reduce costs for the society.Correspondence should be addressed to J Bollerslev . His special interest is within clinical and translational endocrinology, and in particular, in classical endocrine diseases, such as acromegaly and Cushing's, often studying bone as target tissues for clinical activity. A major topic has been clinical management of acromegaly, and especially searching for biomarkers for responsiveness to medical therapy. Prospectively collected data of newly diagnosed patients with acromegaly has been the background for current studies of individualised, multimodal and transdisciplinary treatment. European Journal of Endocrinology 181:2 R60 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R61 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R63 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R64 Review J Bollerslev and others Managing acromegaly https://eje.bioscie...

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Section: Radiation Therapymentioning

confidence: 96%

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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“…51 Major side effect of radiotherapy is hypopituitarism, observed in 70% of treated patients, while optic nerve lesions, cerebrovascular impairment or secondary tumorigenesis are much less frequent. 52 SRT is not recommended when tumor is in high proximity to optic chiasm. SRT modalities available in Serbia include "gamma knife" and "X knife".…”

Section: Combined Medical Treatmentmentioning

confidence: 99%

“…Pegvisomant, as a drug not targeting the pituitary tumor, should not influence radio-sensitivity and does not need to be discontinued. 52 Radiotherapy should be considered in following cases: IGF1 level, Tumor profile) questionnaires. [53][54][55] In more than 50% of acromegaly patients, application of all treatment modalities is necessary.…”

Section: Combined Medical Treatmentmentioning

confidence: 99%

The place of medical treatment of acromegaly in Serbia: Current status

Doknic

Stojanović

2021

VOJNOSANIT PREGL

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The past two decades have brought significant advancement in treatment of acromegaly, primarily due to discovery of new medications and broadening of their availability. Accordingly, mortality rate of patients with acromegaly has decreased significantly and in adequately treated patients it approximates the general population. Treatment of acromegaly requires a combination of several modalities: neurosurgical operation, medical treatment and radiotherapy. Treatment of acromegaly in Serbia is conducted in accordance to international guidelines and recommendations. Recent availability of novel medical therapies for acromegaly in Serbia, demanded a need for creation of recommendations for optimal application of these new treatment options. Medical treatment of acromegaly encompasses three groups of drugs: 1) somatostatin receptor ligands, 2) dopamine agonists, 3) GH receptor antagonists. Every patient requires individual approach in treatment selection, usually involving a combination of multiple treatment modalities. Considerable cost of some medications, even in the economically developed countries, poses an additional challenge for the endocrinologist responsible for selection of treatment. Individualized approach to treatment ensures better disease control, reduction or elimination of comorbidities and reduction in cost of treatment of this chronic disease.

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“…Another second-line therapy is the use of radiation, which can be delivered in a variety of different timing schedules and with variations in the radiation physics in a number of different modalities that are currently in use [19,20]. Conventional fractionated teletherapy has been used for some time but currently is being supplanted by more focused methodologies termed stereotactic radiosurgery.…”

Section: Adjunctive Radiation Therapymentioning

confidence: 99%

The Surgical Management of Acromegaly

Kilgallon¹,

Laws²

2020

Growth Disorders and Acromegaly

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Acromegaly is the condition produced by one of the benign tumors of the pituitary gland. These tumors produce a variety of disorders affecting many parts of the body, producing side effects related to abnormal hormone function. The dramatic appearance of the acromegalic giant has attracted attention over the ages. This chapter summarizes the history of the recognition and ultimate diagnosis of acromegaly. The biological and physiological elements are described. The methods of diagnosis and management are elaborated. Although the focus of the chapter is on the surgical approach for treatment, alternative strategies are also discussed, along with the outcomes of management for patients and the restoration of quality of life as a primary goal.

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Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study

Abstract: SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.

Cited by 66 publications

References 31 publications

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

The place of medical treatment of acromegaly in Serbia: Current status

The Surgical Management of Acromegaly

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