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

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

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

17 Scopus citations

Abstract

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 2.5ng/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.

Original languageEnglish
Pages (from-to)416-420
Number of pages5
JournalJournal of the Formosan Medical Association
Volume112
Issue number7
DOIs
StatePublished - 07 2013

Keywords

  • Acromegaly
  • Growth hormone
  • LINAC
  • Pituitary gland
  • Radiosurgery

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