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CyberKnife robotic radiosurgery in the multimodal management of acromegaly patients with invasive macroadenoma: a single center’s experience
- Source :
- Journal of Neuro-Oncology. 138:291-298
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Surgery is the primary treatment for acromegaly. However, surgery may not be curative of some tumors, particularly invasive macroadenomas. Adjuvant radiation, specifically robotic stereotactic radiosurgery (rSRS), may improve the endocrine outcome. We retrospectively reviewed hormonal and radiological data of 22 acromegalic patients with invasive macroadenomas treated with rSRS at Stanford University Medical Center between 2000 and 2016. Prior to treatment, the tumor's median maximal diameter was 19 mm (2.5-50 mm). Cavernous sinus invasion occurred in 19 patients (86.3%) and compression of the optic chiasm in 2 (9.0%). At last follow up, with an average follow up of 43.2 months, all patients had a reduction in their IGF-1 levels (median IGF-1% upper limit of normal (ULN) baseline: 136% vs last follow up: 97%; p = 0.05); 9 patients (40.9%) were cured, and 4 (18.1%) others demonstrated biochemical control of acromegaly. The median time to cure was 50 months and the mean interval to cure or biochemical control was 30.3 months (± 24 months, range 6-84 months). Hypopituitarism was present in 8 patients (36.3%) and new pituitary deficits occurred in 6 patients with a median latency of 31.6 ± 14.5 months. At final radiologic follow-up, 3 tumors (13.6%) were smaller and 19 were stable in size. The mean biologically effective dose (BED) was higher in subjects cured compared to those with persistent disease, 163 Gy3 (± 47) versus 111 Gy3 (± 43), respectively (p = 0.01). No patient suffered visual deterioration. Robotic SRS is a safe and effective treatment for acromegaly: radiation-induced visual complications and hypopituitarism is rare.
- Subjects :
- Adenoma
Adult
Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Optic chiasm
030209 endocrinology & metabolism
Hypopituitarism
Radiosurgery
Single Center
Effective dose (radiation)
03 medical and health sciences
0302 clinical medicine
Robotic Surgical Procedures
Cyberknife
Acromegaly
medicine
Humans
Pituitary Neoplasms
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Disease Management
Middle Aged
medicine.disease
Surgery
Treatment Outcome
medicine.anatomical_structure
Neurology
Oncology
Cavernous sinus
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 15737373 and 0167594X
- Volume :
- 138
- Database :
- OpenAIRE
- Journal :
- Journal of Neuro-Oncology
- Accession number :
- edsair.doi.dedup.....204ffb3a5ae35df097050d7c20ca7773