Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry

Author:

Knappe U J1,Petroff D2,Quinkler M3,Schmid S M4,Schöfl C5,Schopohl J6,Stieg M R7,Tönjes A8,_ _

Affiliation:

1. 1Department of Neurosurgery, Johannes Wesling Hospital, Minden, Germany

2. 2Clinical Trial Centre, University of Leipzig, Leipzig, Germany

3. 3Endocrinology in Charlottenburg, Stuttgarter Platz, Berlin, Germany

4. 4Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany

5. 5Centers of Endocrinology and Metabolism, Bamberg and Erlangen, Bamberg, Germany

6. 6Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, Munich, Germany

7. 7Max-Planck-Institute of Psychiatry, Munich, Germany

8. 8University of Leipzig Medical Center, Medical Department III – Endocrinology, Nephrology, Rheumatology, Leipzig, Germany

Abstract

Background If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated. Objective To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function. Design and methods A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0–45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication. Results Time between radiotherapy and last follow-up was 13.0 ± 8.2 years for FRT (n = 233) and 8.9 ± 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9–16.2) ng/mL for FRT and 3.5 (1.8–6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is −18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30–1.00, P = 0.049) in SRS compared to FRT patients. Conclusion Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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