Long-term follow-up of patients with surgical intractable acromegaly after linear accelerator radiosurgery

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• 作者：Jiun-Lin Yan ; Chen-Nen Chang ; Chi-Cheng Chuang ; Peng-Wei Hsu ; Jen-Der Lin ; Kuo-Chen Wei ; Shi-Tseng Lee ; Jen-Kan Tseng ; Ping-Ching Pai ; Yao-Liang Chen
• 关键词：acromegaly ; growth hormone ; LINAC ; pituitary gland ; radiosurgery
• 刊名：Journal of the Formosan Medical Association
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：112
• 期：7
• 页码：416-420
• 全文大小：513 K

文摘

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Background/Purpose

Radiotherapy is a crucial treatment for acromegalic patients with growth hormone (GH)-secreting pituitary tumors. However, its effect takes time. We retrospectively reviewed the long-term outcome of linear accelerator stereotactic radiosurgery (LINAC SRS) for patients with acromegaly from the perspective of biochemical remission and associated factors.

Methods

Twenty-two patients presenting with residual or recurrent (GH)-secreting functional pituitary tumor between 1994 and 2004 who received LINAC SRS were enrolled and followed up for at least 3 years. Residual or recurrent tumor was defined as persistent elevated GH or insulin-like growth factor-1 (IGF-1) level and image-confirmed tumor after previous surgical treatment. Biochemical remission was defined as fasting GH less than 2.5?ng/mL with normal sex-and-age adjusted IGF-1.

Results

The mean follow-up period was 94.7 months (range 36-161 months). Overall mean biochemical remission time was 53 months (median 30 months). Biochemical control was achieved in 15 patients (68.2 % ) over the follow up period. One patient experienced recurrence after SRS and underwent another operation. Initial GH at diagnosis and pre-SRS GH correlated with biochemical control (p?=?0.005 and p?<?0.0001, respectively). Further evaluation demonstrated that biochemical control stabilized after 7.5 years. Overall post-SRS hormone deficit persisted in five patients (22.7 % ).

Conclusion

In comparison to other radiosurgery modalities, LINAC radiosurgery also provides a satisfactory outcome. SRS has maximum effect over the first 2 years and stabilizes after 7.5 years. Moreover, SRS elicits long-term biochemical effects and requires longer follow-up for better biochemical remission.