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Outcome of Stereotactic Radiotherapy for Patients with Uncontrolled Acromegaly

Published online by Cambridge University Press:  02 December 2014

Syed Ali Imran
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Ian G. Fleetwood
Affiliation:
Halifax Neuropituitary Program and Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Colleen M. O'Connell
Affiliation:
Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada
Thomas P. Ransom
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Liam A. Mulroy
Affiliation:
Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
Ehud Ur
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
David B. Clarke*
Affiliation:
Halifax Neuropituitary Program and Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
*
Halifax Neuropituitary Program, Division of Neurosurgery, 1796 Summer Street, Room 3807, Halifax, Nova Scotia, B3A 3A7, Canada
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Abstract

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Objective:

Linear accelerator based stereotactic radiation therapy (SRT) has been used for the treatment of pituitary tumours; however, little is known concerning the use of this modality for the treatment of patients with acromegaly. We have prospectively studied the short-term outcome of SRT in 12 acromegaly patients who failed to achieve biochemical remission despite surgery and/or pharmacologic therapy.

Methods:

We identified all patients who had biochemically uncontrolled acromegaly and were treated with SRT between April 2003 and December 2006. All patients were followed prospectively based on a pre-defined protocol that included Goldman visual field examination, MRI of the sella, and pituitary hormone testing at 3, 6, 12 months, and then yearly.

Results:

A total of 12 patients with acromegaly were treated with SRT. There were 9 females and the median age of the group was 50 years. The median follow-up was 28.5 months during which time the mean tumor volume decreased by 40%, the median GH fell from 4.1 μg/L to 1.3 μg/L (p=0.003) and the median IGF-1 dropped more than half from 545.5 μg/L to 260.5 μg/L (p=0.002). Four patients achieved normal, while an additional 2 achieved near-normal, IGF-1 levels. One patient was able to discontinue and two were able to reduce their acromegaly medications while maintaining a normal IGF-1. A new pituitary hormonal deficit was found at 24 months in one patient who developed hypoadrenalism requiring corticosteroid replacement.

Conclusion:

Based on our early experience, we believe that SRT should be considered in treating patients with uncontrolled acromegaly.

Résumé:

RÉSUMÉ:Objectif :

La radiothérapie stéréotaxique (RTS) par accélérateur linéaire est utilisée pour le traitement des tumeurs hypophysaires. Cependant, on connaît peu de choses sur l’utilisation de ce mode de traitement chez les patients atteints d’acromégalie. Nous avons étudié de façon prospective le résultat thérapeutique à court terme de la RTS chez 12 patients atteints d’acromégalie, chez qui la chirurgie et/ou la pharmacothérapie n’a pas provoqué de rémission biochimique.

Méthodes :

Nous avons identifié tous les patients dont l’acromégalie n’était pas maîtrisée au point de vue biochimique, qui ont été traités par RTS entre avril 2003 et décembre 2006. Tous les patients ont été suivis de façon prospective selon un protocole prédéterminé comportant un examen des champs visuels (Goldman), une IRM de la selle turcique et un bilan hormonal hypophysaire après 3, 6, et 12 mois, puis annuellement.

Résultats :

Douze patients atteints d’acromégalie, dont 9 femmes, ont été traités par RTS. L’âge médian des patients était de 50 ans et le suivi médian était de 28,5 mois. Le volume moyen de la tumeur a diminué de 40%, le taux médian de somatotrophine est passé de 4,1 μg/L à 1,3 μg/L (p = 0,003) et le taux médian d’IGF-1 a chute de plus de la moitié, passant de 545,5 μg/L à 260,5 μg/L (p = 0,002). Le taux d’IGF-1 est redevenu normal chez quatre patients et quasi normal chez deux autres. Un patient a pu cesser de prendre ses médicaments pour traiter l’acromégalie et deux autres ont pu en réduire la posologie tout en maintenant un IGF-1 normal. Un nouveau déficit hormonal hypophysaire a été constaté chez un patient après 24 mois de suivi, soit un hypoadrénalisme nécessitant un remplacement par des corticostéroïdes.

Conclusion :

Suite à ces premières observations, nous croyons que la RTS devrait être envisage chez les patients qui présentent une acromégalie rebelle.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2009

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