Gamma Knife radiosurgery for acromegaly: Evaluating the role of the biological effective dose associated with endocrine remission in a series of 42 consecutive cases.
Gamma Knife
acromegaly
biological effective dose
endocrine
radiosurgery
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
11
06
2020
revised:
01
09
2020
accepted:
06
09
2020
pubmed:
29
9
2020
medline:
30
7
2021
entrez:
28
9
2020
Statut:
ppublish
Résumé
Stereotactic radiosurgery (SRS) is a valuable treatment option for persistent and/or recurrent acromegaly secondary to growth hormone (GH) secreting pituitary adenoma (PA). Here, we assess the role of biological effective dose (BED) received by PA treated with SRS in relation with endocrine remission. Forty-two patients (minimum 6 months follow-up) were included. Mean marginal dose was 27.7 (median 28, 20-35), and mean BED received by tumour was 193.1 Gy Mean follow-up period was 62.5 months (median 60.5, 9-127). Probability of IGF-1 normalization was 65% at 3 years and 72.4% at 4 years, remaining stable until last follow-up. Twenty-two (52.4%) patients had complete endocrine remission in absence of any Somatostatin analogues. Actuarial rates were 33% at 3 years and 57.4% at 7 years, further remaining stable during follow-up course. In univariate analysis, only statistically significant parameter was pretherapeutic serum IGF-1 and IGF-1 index (p = .01). Five patients (5/26, 19.3%) without previous hypopituitarism developed new pituitary insufficiency. H-BEDtm was associated with higher rates of endocrine remission compared with L-BEDtm, with actuarial probability of 70.2% versus 48.2% at 9 years, although this did not reach statistical significance (p > .05). Our study confirms that SRS by Gamma Knife is safe and effective for GH-secreting PA. Pretherapeutic serum levels of IGF-1 were only statistically significant parameter for endocrine remission.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
424-433Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Melmed S, Casanueva FF, Cavagnini F, et al. Guidelines for acromegaly management. J Clin Endocrinol Metab. 2002;87(9):4054-4058.
Melmed S, Colao A, Barkan A, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94(5):1509-1517.
Ludecke DK, Abe T. Transsphenoidal microsurgery for newly diagnosed acromegaly: a personal view after more than 1,000 operations. Neuroendocrinology. 2006;83(3-4):230-239.
Biermasz NR, van Dulken H, Roelfsema F. Ten-year follow-up results of transsphenoidal microsurgery in acromegaly. J Clin Endocrinol Metab. 2000;85(12):4596-4602.
Laws ER. Surgery for acromegaly: evolution of the techniques and outcomes. Rev Endocr Metab Disord. 2008;9(1):67-70.
Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol. 2005;152(3):379-387.
Phan K, Xu J, Reddy R, Kalakoti P, Nanda A, Fairhall J. Endoscopic endonasal versus microsurgical transsphenoidal approach for growth hormone-secreting pituitary adenomas-systematic review and meta-analysis. World Neurosurg. 2017;97:398-406.
Ben-Shlomo A, Melmed S. Clinical review 154: the role of pharmacotherapy in perioperative management of patients with acromegaly. J Clin Endocrinol Metab. 2003;88(3):963-968.
Franzin A, Spatola G, Losa M, Picozzi P, Mortini P. Results of gamma knife radiosurgery in acromegaly. Int J Endocrinol. 2012;2012:342034.
Lee CC, Vance ML, Xu Z, et al. Stereotactic radiosurgery for acromegaly. J Clin Endocrinol Metab. 2014;99(4):1273-1281.
Rolston JD, Blevins LS Jr. Gamma knife radiosurgery for acromegaly. Int J Endocrinol. 2012;2012:821579.
Pollock BE, Jacob JT, Brown PD, Nippoldt TB. Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg. 2007;106(5):833-838.
Zhang N, Pan L, Wang EM, Dai JZ, Wang BJ, Cai PW. Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg. 2000;93(Suppl 3):6-9.
Jagannathan J, Sheehan JP, Pouratian N, Laws ER Jr, Steiner L, Vance ML. Gamma knife radiosurgery for acromegaly: outcomes after failed transsphenoidal surgery. Neurosurgery. 2008;62(6):1262-1270; discussion 9-70.
Cohen-Inbar O, Ramesh A, Xu Z, Vance ML, Schlesinger D, Sheehan JP. Gamma knife radiosurgery in patients with persistent acromegaly or Cushing's disease: long-term risk of hypopituitarism. Clin Endocrinol. 2016;84(4):524-531.
Tuleasca C, Leroy HA, Regis J, Levivier M. Gamma Knife radiosurgery for cervical spine lesions: expanding the indications in the new era of Icon. Acta Neurochir. 2016;158(11):2235-2236.
Minniti G, Clarke E, Scaringi C, Enrici RM. Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas. Rep Pract Oncol Radiother. 2016;21(4):370-378.
Tuleasca C, Paddick I, Hopewell JW, et al. Establishment of a therapeutic ratio for gamma knife radiosurgery of trigeminal neuralgia: the critical importance of biologically effective dose versus physical dose. World Neurosurg. 2019;134:e204-e213.
Tuleasca C, Regis J, Levivier M. Letter: treatment outcomes and dose rate effects following gamma knife stereotactic radiosurgery for vestibular schwannomas. Neurosurgery. 2019;86(2):E252-E253.
Graffeo CS, Donegan D, Erickson D, et al. The impact of insulin-like growth factor index and biologically effective dose on outcomes after stereotactic radiosurgery for acromegaly: cohort Study. Neurosurgery. 2020. https://doi.org/10.1093/neuros/nyaa054
Regis J, Tuleasca C, Hopewell JW, Castinetti F. Commentary: the impact of insulin-like growth factor index and biological effective dose on outcomes after stereotactic radiosurgery for acromegaly: cohort study. Neurosurgery. 2020;87(3):E301-E302. https://doi.org/10.1093/neuros/nyaa123
Jayasena CN, Comninos AN, Clarke H, Donaldson M, Meeran K, Dhillo WS. The effects of long-term growth hormone and insulin-like growth factor-1 exposure on the development of cardiovascular, cerebrovascular and metabolic co-morbidities in treated patients with acromegaly. Clin Endocrinol. 2011;75(2):220-225.
Jones B, Hopewell JW. Modelling the influence of treatment time on the biological effectiveness of single radiosurgery treatments: derivation of “protective” dose modification factors. Brit J Radiol. 2018;92(1093):20180111. https://doi.org/10.1259/bjr.20180111
Giustina A, Chanson P, Bronstein MD, et al. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab. 2010;95(7):3141-3148.
Melmed S, Bronstein MD, Chanson P, et al. A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018;14(9):552-561.
Wolf A, Naylor K, Tam M, et al. Risk of radiation-associated intracranial malignancy after stereotactic radiosurgery: a retrospective, multicentre, cohort study. Lancet Oncol. 2019;20(1):159-164.
Ding D, Mehta GU, Patibandla MR, et al. Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study. Neurosurgery. 2019;84(3):717-725.
Castinetti F, Nagai M, Morange I, et al. Long-term results of stereotactic radiosurgery in secretory pituitary adenomas. J Clin Endocrinol Metab. 2009;94(9):3400-3407.
Landolt AM, Haller D, Lomax N, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg. 1998;88(6):1002-1008.
Iwai Y, Yamanaka K, Yoshioka K, Kanai M. Gamma knife radiosurgery for GH-secreting microadenoma with empty sella. J Clin Neurosci. 2004;11(4):418-421.
Shepard MJ, Mehta GU, Xu Z, et al. Technique of whole-sellar stereotactic radiosurgery for cushing disease: results from a multicenter, International Cohort Study. World Neurosurg. 2018;116:e670-e679.
Lee CC, Chen CJ, Yen CP, et al. Whole-sellar stereotactic radiosurgery for functioning pituitary adenomas. Neurosurgery. 2014;75(3):227-237. discussion 37.
Girkin CA, Comey CH, Lunsford LD, Goodman ML, Kline LB. Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology. 1997;104(10):1634-1643.
Leavitt JA, Stafford SL, Link MJ, Pollock BE. Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2013;87(3):524-527.
Daniel RT, Tuleasca C, Messerer M, et al. Optimally invasive skull base surgery for large benign tumors. In: Berhouma M, ed. Minimally Invasive Skull Base Surgery: Principles and Practice. Nova Science Publishers; 2013:325-355.
Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz JC, Pendl G. A six year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg. 1999;72(Suppl 1):88-100.
Pan L, Zhang N, Wang E, Wang B, Xu W. Pituitary adenomas: the effect of gamma knife radiosurgery on tumor growth and endocrinopathies. Stereotact Funct Neurosurg. 1998;70(Suppl 1):119-126.
Pollock BE, Nippoldt TB, Stafford SL, Foote RL, Abboud CF. Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg. 2002;97(3):525-530.
Castinetti F, Brue T. Gamma Knife radiosurgery in pituitary adenomas: why, who, and how to treat? Discov Med. 2010;10(51):107-111.
Feigl GC, Pistracher K, Berghold A, Mokry M. Pituitary insufficiency as a side effect after radiosurgery for pituitary adenomas: the role of the hypothalamus. J Neurosurg. 2010;113(Suppl):153-159.
Marek J, Jezkova J, Hana V, et al. Is it possible to avoid hypopituitarism after irradiation of pituitary adenomas by the Leksell gamma knife? Eur J Endocrinol. 2011;164(2):169-178.
Arai Y, Kano H, Lunsford LD, et al. Does the Gamma Knife dose rate affect outcomes in radiosurgery for trigeminal neuralgia? J Neurosurg. 2010;113(Suppl):168-171.
Lee JY, Sandhu S, Miller D, Solberg T, Dorsey JF, Alonso-Basanta M. Higher dose rate Gamma Knife radiosurgery may provide earlier and longer-lasting pain relief for patients with trigeminal neuralgia. J Neurosurg. 2015;123(4):961-968.
Paddick I, Hopewell JW, Klinge T, Graffeo CS, Pollock BE, Sneed PK. Letter: treatment outcomes and dose rate effects following gamma knife stereotactic radiosurgery for vestibular schwannomas. Neurosurgery. 2019;86(4):E407-E409.
Millar WT, Canney PA. Derivation and application of equations describing the effects of fractionated protracted irradiation, based on multiple and incomplete repair processes. Part 2. Analysis of mouse lung data. Int J Radiat Biol. 1993;64(3):293-303.
Millar WT, Canney PA. Derivation and application of equations describing the effects of fractionated protracted irradiation, based on multiple and incomplete repair processes. Part I. Derivation of equations. Int J Radiat Biol. 1993;64(3):275-291.
Hopewell JW, Millar WT, Lindquist C. Radiobiological principles: their application to gamma knife therapy. Prog Neurol Surg. 2012;25:39-54.