Gamma-Knife Surgery is Effective in Normalising Plasma Insulin-Like Growth Factor I in Patients with Acromegaly

Abstract

We have shown that pituitary gamma-knife surgery is effective in lowering serum IGF-I levels. At the end of the follow-up period, 48 % of our cohort had normal age-adjusted IGF-I levels.

Efficacy and safety of CyberKnife radiosurgery for acromegaly

“…This suggests that CK SRS is an effective adjuvant for acromegalic patients with persistent, active disease following surgery or medical therapy. The rate of biochemical remission or control achieved is similar to that seen with other forms of SRS [31,32,[34][35][36], and as recently well summarized by Sheehan et al [39]. The mean time to serum IGF-1 normalization was 12 months.…”

“…In this study, 14 (17%) patients developed at least one new anterior pituitary deficiency, but the incidence of other side effects was rare [32]. Further studies using SRS (typically Gamma Knife) on smaller numbers of subjects have shown control rates ranging from 23 to 90% [33][34][35][36][37]. In addition, Landolt et al [11] showed that 16 patients treated with adjuvant Gamma Knife radiosurgery achieved rates of biochemical remission comparable to those in 50 patients who received fractionated RT.…”

A systematic analysis of disease control in acromegaly treated with radiosurgery

“…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.…”

“…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.…”

Treatment of acromegaly: is there still a place for radiotherapy?

“…In recent years, conventional RT has been progressively replaced by stereotactic RT, the major reasons being better target selectivity with lower incidence of cerebral vascular disease and secondary neoplasia [15] and a shorter latency period to achieve hormonal control [16][17][18].…”