Gamma-Knife Radiosurgery in Acromegaly: A 4-Year Follow-Up Study

Attanasio, Roberto; Epaminonda, Paolo; Motti, Enrico; Giugni, Enrico; Ventrella, Laura; Cozzi, Renato; Farabola, M.; Loli, Paola; Beck‐Peccoz, Paolo; Arosio, Maura

doi:10.1210/jc.2002-021663

Cited by 194 publications

(127 citation statements)

References 41 publications

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“…In our patients, as in another recently published series of acromegalic patients treated with GK, remission rate was about 20% with a follow-up of about 48 months (25,26). In the present study in CD, the mean time to remission was 22 vs 36 months in our patients with acromegaly (25).…”

Section: Discussionsupporting

confidence: 80%

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Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

159

118

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Objective: Though transsphenoidal surgery remains the first-line treatment of Cushing's disease, recurrence occurs frequently. Conventional radiotherapy and anticortisolic drugs both have adverse effects. Stereotactic radiosurgery needs to be evaluated more precisely. The aim of this study was to determine long-term hormonal effects and tolerance of gamma knife (GK) radiosurgery in Cushing's disease. Design: Forty patients with Cushing's disease treated by GK were prospectively studied over a decade, with a mean follow-up of 54.7 months. Eleven of them were treated with GK as a primary treatment. Methods: Radiosurgery was performed at the Department of Functional Neurosurgery of Marseille, France, using the Leksell Gamma Unit B and C models. Median margin dose was 29.5 Gy. Patients were considered in remission if they had normalized 24-h free urinary cortisol and suppression of plasma cortisol after low-dose dexamethasone suppression test. Results: Seventeen patients (42.5%) were in remission after a mean of 22 months (range 12-48 months). The two groups did not differ in terms of initial hormonal levels. Target volume was significantly higher in uncured than in remission group (909.8 vs 443 mm 3 , PZ0.038). We found a significant difference between patients who were on or off anticortisolic drugs at the time of GK (20 vs 48% patients in remission respectively, PZ0.02). Conclusion: With 42% of patients in remission after a median follow-up of 54 months, GK stereotactic radiosurgery, especially as an adjunctive treatment to surgery, may represent an alternative to other therapeutic options in view of their adverse effects.European Journal of Endocrinology 156 91-98

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Section: Discussionsupporting

confidence: 80%

“…Some studies suggested that the pre-GK somatostatin agonist (24) treatment had a radioprotective effect (24) and some did not (25,26). We found a significantly higher proportion of uncured patients in the group with anticortisolic drug at the time of GK than in the group without medical therapy.…”

Section: Discussionmentioning

confidence: 52%

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

159

118

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“…Overall radiation-based treatment in mixed series induces hypopituitarism in almost half of the patients over a long follow-up (Jallad et al 2007). In cohorts treated solely with stereotactic methods variable rates of hypopituitarism have been reported from below 10% at 3.8 years (Attanasio et al 2003) to 31% at 8 years (Lee et al 2014a), 12-20% in most series (Milker-Zabel et al 2001, Pollock et al 2002, Wilson et al 2013, especially in large tumor masses (Pollock et al 2002, Beauregard et al 2003. Owing to the possibility of late hypopituitarism, long-term follow-up and periodic testing are mandatory after RT.…”

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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“…Stereotactic radiosurgery, on the other hand, is single-dose treatment that is an effective method of delivering radiation treatment to GH-secreting tumours, whilst minimising the risk of radiation to surrounding tissues. Available data suggest that pituitary hypersecretion may resolve faster with stereotactic radiosurgery, but long-term data are still awaited (14,15). Recent advances in medical treatment have raised the prospect of obtaining biochemical control in virtually every subject, with consequent relief of symptoms and restoration of life expectancy to normal.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

et al. 2005

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Background: The excess mortality and morbidity associated with acromegaly are secondary to prolonged elevation of GH and IGF-I. Vigorous control of these biochemical parameters results in improved morbidity and mortality. Somatostatin analogues (SAs) allow adequate control of GH and IGF-I in approximately 65% of subjects, leaving a significant cohort uncontrolled. Dopamine agonists (DAs), a cheap alternative to SAs, allow control of GH and IGF-I in less than 20% of patients with acromegaly. Aims: To assess the effectiveness of adding DA therapy to SA in the biochemical control of acromegaly. Subjects: One hundred and twenty cases from the Sheffield Acromegaly Register were reviewed; 24 (20%) did not require medical treatment following pituitary surgery alone; 16 (13%) had safe GH levels following surgery and radiotherapy; and 58 (48%) required medical treatment despite having had surgery, radiotherapy or both. The remaining 22 (18%) received only medical treatment. Methods: In nine subjects a DA (three bromocriptine, six cabergoline) was added to an SA to control active disease. GH day curves and IGF-I levels were compared before and after the addition of a DA to existing SA treatment. All were on stable maximum-dose treatment with an SA, with inadequate biochemical control prior to addition of DA therapy. Mean duration of treatment on a DA before biochemical assessments were made was 10.3 months. Six subjects had previously been treated with either transsphenoidal surgery, radiotherapy or both. In three subjects SA was the primary therapy. Results: All subjects exhibited a fall in median GH and IGF-I levels. Introduction of a DA resulted in a 36.1% reduction in median GH levels (8.3 vs 5.3 mIU/l; P ¼ 0.008) on a GH day curve and a 35.2% reduction in IGF-I levels (387.2 vs 251.0 mg/l; P ¼ 0.018). Only four subjects had elevated prolactin levels prior to the addition of a DA (. 368 mIU/l). Conclusion: Addition of DAs to SAs is of benefit in the biochemical control of acromegaly and should be considered in those inadequately controlled. Furthermore, the beneficial effects of DAs occur even when pre-treatment prolactin levels are within the normal range.

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Gamma-Knife Radiosurgery in Acromegaly: A 4-Year Follow-Up Study

Cited by 194 publications

References 41 publications

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

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