Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study

Clayton E. Alonso, Adomas Bunevicius, Daniel M. Trifiletti, James Larner, Cheng Chia Lee, Fu Yuan Pai, Roman Liscak, Mikulas Kosak, Hideyuki Kano, Nathaniel D. Sisterson, David Mathieu, L. Dade Lunsford, Jason P. Sheehan

Research output: Contribution to journalArticle

Abstract

Purpose: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. Methods: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. Results: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. Conclusions: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

Original languageEnglish (US)
Pages (from-to)301-307
Number of pages7
JournalJournal of neuro-oncology
Volume145
Issue number2
DOIs
StatePublished - Nov 1 2019

Fingerprint

Acromegaly
Radiosurgery
Safety
Neoplasms
Neurologic Manifestations
Insulin-Like Growth Factor I
Adenoma
Growth Hormone

Keywords

  • Acromegaly
  • Gamma Knife radiosurgery
  • Pituitary adenoma
  • Radiosurgery
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Safety and efficacy of repeat radiosurgery for acromegaly : an International Multi-Institutional Study. / Alonso, Clayton E.; Bunevicius, Adomas; Trifiletti, Daniel M.; Larner, James; Lee, Cheng Chia; Pai, Fu Yuan; Liscak, Roman; Kosak, Mikulas; Kano, Hideyuki; Sisterson, Nathaniel D.; Mathieu, David; Lunsford, L. Dade; Sheehan, Jason P.

In: Journal of neuro-oncology, Vol. 145, No. 2, 01.11.2019, p. 301-307.

Research output: Contribution to journalArticle

Alonso, CE, Bunevicius, A, Trifiletti, DM, Larner, J, Lee, CC, Pai, FY, Liscak, R, Kosak, M, Kano, H, Sisterson, ND, Mathieu, D, Lunsford, LD & Sheehan, JP 2019, 'Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study', Journal of neuro-oncology, vol. 145, no. 2, pp. 301-307. https://doi.org/10.1007/s11060-019-03296-8
Alonso, Clayton E. ; Bunevicius, Adomas ; Trifiletti, Daniel M. ; Larner, James ; Lee, Cheng Chia ; Pai, Fu Yuan ; Liscak, Roman ; Kosak, Mikulas ; Kano, Hideyuki ; Sisterson, Nathaniel D. ; Mathieu, David ; Lunsford, L. Dade ; Sheehan, Jason P. / Safety and efficacy of repeat radiosurgery for acromegaly : an International Multi-Institutional Study. In: Journal of neuro-oncology. 2019 ; Vol. 145, No. 2. pp. 301-307.
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abstract = "Purpose: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. Methods: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. Results: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3{\%}) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9{\%}) patients had endocrine remission at last follow-up visit. Four patients (19.0{\%}) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. Conclusions: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.",
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AU - Alonso, Clayton E.

AU - Bunevicius, Adomas

AU - Trifiletti, Daniel M.

AU - Larner, James

AU - Lee, Cheng Chia

AU - Pai, Fu Yuan

AU - Liscak, Roman

AU - Kosak, Mikulas

AU - Kano, Hideyuki

AU - Sisterson, Nathaniel D.

AU - Mathieu, David

AU - Lunsford, L. Dade

AU - Sheehan, Jason P.

PY - 2019/11/1

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N2 - Purpose: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. Methods: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. Results: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. Conclusions: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

AB - Purpose: Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. Methods: Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. Results: Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. Conclusions: Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

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KW - Gamma Knife radiosurgery

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KW - Radiosurgery

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