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Submitted on February 11, 2005
Accepted on May 5, 2005
Knife Radiosurgery in 82 Patients With Acromegaly: Correlation with Initial Hypersecretion
Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition (F.C., D.T., P.J., B.C-D., T.B.), Department of Neurosurgery and Functional Neurosurgery (M.T., J.R., H.D.), Department of Neurosurgery (H.D.), Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, 13385 Marseille, France; Department of Endocrinology and Metabolic Diseases (J.-M.K.), Centre Hospitalier Universitaire de Rouen, 76031 Rouen, France; Department of Endocrinology and Reproductive Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre and Faculté de Médecine Paris XI, 94270 Le Kremlin Bicêtre (P.C.), France
* To whom correspondence should be addressed. E-mail: thierry.brue{at}mail.ap-hm.fr.
Context: as surgical and medical therapies of acromegaly all have specific limitations, radiotherapy has been used as an adjunctive strategy. Stereotactic radiosurgery has yet not been widely evaluated.
Objective: analysis of long-term hormonal effects and tolerance of 
Knife radiosurgery.
Design: 82 patients were prospectively studied over a decade with a mean follow up of 49.5 months.
Setting: All patients were treated at the Department of Functional Neurosurgery of Marseille, France.
Patients: 82 patients with active acromegaly, of whom 63 had previous transsphenoidal surgery.
Intervention: Radiosurgery using the Leksell Unit B model.
Main outcome measures: remission was diagnosed when mean GH levels were less than 2 ng/ml and IGF-1 was normal for age off somatostatin agonists (at least 3 months).
Results: 17% of the patients were in remission without any treatment. 23% previously uncontrolled on somatostatin agonists fulfilled the same criteria after knife while maintained on medical treatment. Initial GH and IGF-1 levels off somatostatin agonists were significantly higher in uncured than in remission group (P = 0.01 and 0.047, respectively). Withdrawal of somatostatin agonists at the time of radiosurgery had no incidence on the outcome. No significant difference was found in success rate whether patients had previously been surgically treated or not. Long-term side effects included complete (n = 2) or partial (n = 12) hypopituitarism diagnosed 1-7 yr after GK.
Conclusions: knife radiosurgery may represent a therapeutic approach in patients with moderate initial or residual growth hormone hypersecretion.
knife •
radiosurgery •
radiotherapy •
acromegaly •
pituitary adenomas
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