Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas-A Multicenter Experience

The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This mul...

Full description

Saved in:
Bibliographic Details
Published in:Cancers 2021-01, Vol.13 (3), p.537
Main Authors: Ehret, Felix, Kufeld, Markus, Fürweger, Christoph, Haidenberger, Alfred, Windisch, Paul, Fichte, Susanne, Lehrke, Ralph, Senger, Carolin, Kaul, David, Rueß, Daniel, Ruge, Maximilian, Schichor, Christian, Tonn, Jörg-Christian, Stalla, Günter, Muacevic, Alexander
Format: Article
Language:English
Subjects:
Acromegaly
Disease control
Growth hormones
Hypopituitarism
Insulin
Insulin-like growth factor I
Insulin-like growth factors
Morbidity
Patients
Pituitary
Radiation therapy
Radiosurgery
Remission
Robotic surgery
Sinuses
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively ( = 0.0001 and = 0.0002). The IGF-1 index was a predictor for biochemical remission ( = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13030537