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The Role of Stereotactic Radiotherapy in Patients with Growth Hormone-Secreting Pituitary Adenoma

Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, 20132 Milano, Italy

Address all correspondence and requests for reprints to: Marco Losa, M.D., Department of Neurosurgery, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy. E-mail: losa.marco{at}hsr.it.

Context: Single-session stereotactic radiotherapy (SR) may be a potential adjuvant treatment in acromegaly.

Objective: We analyzed the safety and efficacy of SR in patients who had previously received maximal surgical debulking at our center.

Design: The study was a retrospective analysis of hormonal, radiological, and ophthalmologic data collected in a predefined protocol from 1994 through 2006.

Setting: The study was performed at a university hospital.

Patients: Eighty-three acromegalic patients, 52 women and 31 men, with a mean age of 42.6 ± 1.2 yr, participated in the study. The median follow-up was 69 months (interquartile range 44–107 months).

Intervention: The patients were treated with SR for residual or recurrent GH-secreting adenoma.

Main Outcome Measure: Normalization of age- and sex-adjusted IGF-I levels together with a basal GH level below 2.5 µg/liter without concomitant GH-suppressive drugs was the goal of therapy.

Results: Fifty patients (60.2%) reached the main outcome of the study. The rate of remission was 52.6% at 5 yr [95% confidence interval (CI) 40.6–64.6%]. Another 13 patients (15.7%), who were resistant to somatostatin analogs, were in remission after SR. Multivariate analysis showed that low basal GH and IGF-I levels were associated with a favorable outcome. No serious side effects occurred after SR. The 5-yr cumulative risk of new onset hypogonadism, hypothyroidism, or hypoadrenalism was 3.6% (95% CI 0–8.6%), 3.3% (95% CI 0–7.7%), and 4.9% (95% CI 0–10.4%), respectively.

Conclusion: In a highly selected group of acromegalic patients, SR treatment had good efficacy and safety. This may lead to reconsider the role of SR in the therapeutic algorithm of acromegaly.