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Primary versus postoperative stereotactic radiosurgery for acromegaly: a multicenter matched cohort study
Nasser Mohammed1, Dale Ding1, Yi-Chieh Hung1
11Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Journal of Neurosurgery
|April 27, 2019
Summary
Primary stereotactic radiosurgery (SRS) offers a viable alternative for acromegaly patients unsuitable for surgery. Outcomes are comparable to those receiving SRS after surgery, demonstrating a good benefit-to-risk profile.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiation Oncology
Background:
- Medically refractory acromegaly poses treatment challenges, especially for patients ineligible for or refusing surgery.
- The efficacy of primary stereotactic radiosurgery (SRS) in such cases remains incompletely understood.
Purpose of the Study:
- To compare the outcomes of primary SRS versus postoperative SRS for acromegaly.
- To evaluate SRS as an alternative treatment modality for selected acromegaly patients.
Main Methods:
- A multicenter, matched cohort study analyzed data from 398 patients with acromegaly treated with SRS.
- 26 patients in the primary SRS cohort were matched 1:2 with 52 patients in the postoperative SRS cohort.
Main Results:
- At 2 and 5 years, actuarial endocrine remission rates in the primary SRS cohort were 20% and 42%, respectively.
- No significant differences were observed between primary and postoperative SRS cohorts in tumor control, remission rates, recurrence, or hypopituitarism.
- Lower pre-SRS IGF-1 predicted initial remission, while lower SRS margin dose predicted recurrence.
Conclusions:
- Primary SRS presents a reasonable benefit-to-risk profile for acromegaly patients not candidates for resection.
- Outcomes of primary SRS are similar to postoperative SRS in endocrinologically comparable patients.
- SRS, combined with medical therapy, can serve as an alternative to surgery for select patients.
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