Radiation Treatment Strategies for Acromegaly

Nathan C. Rowland, M.D., Ph.D.; Manish K. Aghi, M.D., Ph.D.

Disclosures

Neurosurg Focus. 2010;29(4):e12 

In This Article

Conclusions

These results from studies of multiple modalities of radiosurgical treatment of acromegaly will require verification in larger series conducted over a longer period of time. Future experimental directions designed to improve the remission rates with radiosurgery for acromegaly could include use of somatostatin receptor scintigraphy to localize adenoma cells[75] and better define a target for radiosurgery. Another goal of future studies will be to document the long-term recurrence rates in patients with acromegaly who achieve remission after radiosurgery. Overall, GKS, present in 109 centers in the US and 30 centers in Europe, is so far the most extensively studied modality with several reports involving 10-year patient follow-up data. Large single-fraction and high-precision doses of radiation with steep falloff are features of radiosurgery that make it an attractive option for adjuvant therapy for refractory acromegaly after transsphenoidal surgery. Its use may be optimally effective in patients who have discontinued their antiacromegaly medication at the time of treatment, have low basal GH and IGF-I levels, and receive higher total integral radiation doses and higher maximal doses. Future multicenter clinical trials that are currently under development such as the Phase II Radiation Therapy Oncology Group (RTOG) trial 0930 will study radiosurgery for the treatment of persistent acromegaly after transsphenoidal surgery and will be poised to confirm the findings to date from smaller studies and to address the other as yet unanswered questions described in this review.

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