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Submitted on May 31, 2005
Accepted on October 20, 2005
1 Department of Molecular and Clinical Endocrinology and Oncology, University "Federico II" of Naples, Italy; 2 Division of Endocrinology, Hospital Niguarda "Ca Granda of Milan, Italy; 3 Department of Neurological Sciences, Section of Neurosurgery, University "Federico II" of Naples, Italy; 4 Division of Neurosurgery, Neurologic Institute Carlo Besta of Milan, Italy
* To whom correspondence should be addressed. E-mail: colao{at}unina.it.
Context: Surgery is a cornerstone in the treatment of acromegaly but its efficacy in large, invasive tumors is scant.
Objective: To investigate whether partial surgical removal of GH-secreting pituitary tumors enhances the response rate to somatostatin analogs [(SSA), s.c. octreotide (OCT), slow-release octreotide (LAR) and lanreotide (LAN)].
Design: Multicenter, open, retrospective.
Setting: University Hospitals.
Patients and Methods: Eighty-six patients (42 women, age 42 ± 14 yr) with acromegaly.
Interventions: Patients underwent two courses of OCT, LAN or LAR treatments before and after surgery of at least 6 months.
Main outcome measures: Normal IGF-I levels for age.
Results: Pre-surgical SSA treatment, significantly decreased GH and IGF-I levels in all patients. GH levels were <2.5 µg/L in 12 (14%); IGF-I levels normalized in 9 (10%). After surgery GH and IGF-I levels further decreased in all patients; tumor removal was >75% in 50 (58%), 50.1-75% in 21 (24%), 25.1-50% in 10 (12%), and <25% in five patients (6%). Pre-operatively pituitary function was impaired in 12 patients (14%). Post-surgical SSA treatment, lowered GH levels <2.5 µg/L in 49 (56%) and normalized IGF-I levels in 48 patients (55%). The success rate was significantly increased compared with pre-surgery (P < 0.0001). GH (r = -0.48, P < 0.0001) and IGF-I levels (r = -0.38, P = 0.0003) after post-surgery SSA treatment correlated with the amount of tumor surgically removed. After surgery, pituitary function impaired in 28 patients (32.6%) and improved in 12 patients (13.9%). The cumulative prevalence of pituitary deficiency did not change during the study (normal function from 40% to 42%; deficiency/ies from 60% to 58%).
Conclusions: Surgical tumor removal (>75%) enhances the response to somatostatin analogs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.
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