Gamma knife radiosurgery (GKS) is a treatment option for recurrent or persistent disease in patients with acromegaly.

Objective

We aimed to retrospectively evaluate acromegaly patients who had undergone GKS in terms of pituitary hormone status, efficacy of GKS, and prognostic factors.

Method

One-hundred and ten acromegaly patients who underwent GKS, and who were referred to our outpatient endocrinology clinic between 2007 and 2017, were included in the study. Anterior pituitary hormones and radiology imaging during follow-up were recorded. Remission for acromegaly was defined as a normal insulin-like growth factor 1 (IGF-1) level adjusted for age and gender, and a random growth hormone (GH) level < 1 ng/ml. Endocrine control was defined as normal GH and IGF-1 levels under medication.

Results

After a mean follow-up of 6.5 ± 4.7 years; remission, endocrine control, and uncontrolled status was observed in 16.4%, 60%, and 23.6% of patients; respectively. Adenoma volume was decreased after GKS (P < .0001). Remnant adenoma diameter was higher in the uncontrolled group compared to the remission and endocrine control group. The presence of tumor extension was associated with disease status (P = .03) and higher initial GH and IGF-1 levels. The mean time after GKS to remission was 26.5 months. Six (5.4%) patients had new-onset pituitary deficiency after GKS. In the multivariate analysis, pre-GKS IGF-1 levels and patient's age were associated with disease status.

Conclusion

GKS is an effective adjuvant treatment with minimal side effects to control GH and IGF-1 levels, increase remission rates, endocrine control, and reduce tumor diameter in persistent acromegaly patients after surgery.

中文翻译：

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伽玛刀放射外科治疗肢端肥大症患者的远期内分泌结果

伽玛刀放射外科 (GKS) 是治疗肢端肥大症患者复发或持续疾病的一种治疗选择。

客观的

我们旨在回顾性评估接受 GKS 的肢端肥大症患者的垂体激素状态、GKS 的疗效和预后因素。

方法

该研究包括了 110 名接受 GKS 治疗并在 2007 年至 2017 年期间转诊到我们门诊内分泌诊所的肢端肥大症患者。记录随访期间的垂体前叶激素和放射成像。肢端肥大症的缓解定义为根据年龄和性别调整的正常胰岛素样生长因子 1 (IGF-1) 水平，以及随机生长激素 (GH) 水平 < 1 ng/ml。内分泌控制被定义为药物治疗下正常的 GH 和 IGF-1 水平。

结果

经过平均 6.5 ± 4.7 年的随访；在 16.4%、60% 和 23.6% 的患者中观察到缓解、内分泌控制和不受控制的状态；分别。GKS 后腺瘤体积减少 ( P  < .0001)。与缓解和内分泌对照组相比，未控制组的残余腺瘤直径更高。肿瘤扩展的存在与疾病状态 ( P  = .03) 和较高的初始 GH 和 IGF-1 水平相关。GKS 缓解后的平均时间为 26.5 个月。6 名 (5.4%) 患者在 GKS 后出现新发垂体缺乏症。在多变量分析中，pre-GKS IGF-1 水平和患者年龄与疾病状态相关。

结论

GKS 是一种有效的辅助治疗，副作用最小，可控制 GH 和 IGF-1 水平，提高缓解率，控制内分泌，并减少手术后持续性肢端肥大症患者的肿瘤直径。