Advertisement

Pituitary

, Volume 10, Issue 1, pp 53–59 | Cite as

Treatment of acromegaly: is there still a place for radiotherapy?

  • Raquel S. Jallad
  • Nina R. Musolino
  • Luiz R. Salgado
  • Marcello D. Bronstein
Article

Abstract

Objective

To evaluate efficacy and safety of radiotherapy on acromegaly treatment.

Design and patients

We followed retrospectively 99 acromegalic patients for at least one year after radiotherapy (RT). RT had been performed after unsuccessful surgery in 91 patients and as primary treatment in eight. Time elapsed between surgery and RT was 1.4 ± 2.4 years. Mean follow-up after RT was 5.9 ± 4.7 years (1–16 years). All patients were treated with linear accelerator, 89 by conventional (3240–6000 cGY) and ten by stereotactic RT.

Measurements

Biochemical remission was defined as GH < 2.5 ng/ml and IGF-I normalization.

Results

At latest follow-up, 54% of patients had serum GH level <2.5 ng/ml; 42% had normal IGF-I and 38% of patients achieved normalization of both. Controlled patients had lower baseline GH and IGF-I levels compared to uncontrolled ones. They achieved remission after 3.8 ± 2.4 years, a significantly lower time length compared to maximum follow-up of uncontrolled (6.0 ± 4.9 year). Results regarding GH and IGF-I levels were similar in patients treated either primarily or after surgery. No patient showed tumor growth. Visual field defects were observed in four, seizures in one, and mental disorders in two patients, although cognitive function were not properly assessed. At the last follow-up, 47% of patients had acquired at least one hormonal deficiency.

Conclusions

There is still a place for RT in acromegaly treatment, mainly for: after non-curative surgery and poor response or inaccessibility to medical treatment; growth restraining of aggressive macroadenomas; co-morbidities that contraindicate surgery and surgery refusal. However, side effects and latency period to achieve disease control should be kept in mind.

Keywords

Acromegaly Radiotherapy Radiosurgery Pituitary tumors Pituitary 

References

  1. 1.
    Barrande G, Pittino-Lungo M, Coste J, Ponvert D, Bertagna X, Luton JP, Bertherat J (2000) Hormonal and metabolic effects of radiotherapy in acromegaly: long-term results in 128 patients followed in a single center. J Clin Endocrinol Metab 85:3779–3785PubMedCrossRefGoogle Scholar
  2. 2.
    Biermasz NR, van Dulken H, Roelfsema F (2000) Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. J Clin Endocrinol Metab 85:2476–2482PubMedCrossRefGoogle Scholar
  3. 3.
    Powell JS, Wardlaw SL, Post KD, Freda PU (2000) Outcome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure. J Clin Endocrinol Metab 85:2068–2071PubMedCrossRefGoogle Scholar
  4. 4.
    Epaminonda P, Porretti S, Cappiello V, Beck-Peccoz P, Faglia G, Arosio M (2001) Efficacy of radiotherapy in normalizing serum IGF-I, acid-labile subunit (ALS) and IGFBP-3 levels in acromegaly. Clin Endocrinol (Oxf) 55:183–189CrossRefGoogle Scholar
  5. 5.
    Minniti G, Jaffrain-Rea ML, Osti M, Esposito V, Santoro A, Solda F, Gargiulo P, Tamburrano G, Enrici RM (2005) The long-term efficacy of conventional radiotherapy in patients with GH-secreting pituitary adenomas. Clin Endocrinol (Oxf) 62:210–216CrossRefGoogle Scholar
  6. 6.
    Swords FM, Allan CA, Plowman PN, Sibtain A, Evanson J, Chew SL, Grossman AB, Besser GM, Monson JP ( 2003) Stereotactic radiosurgery XVI: a treatment for previously irradiated pituitary adenomas. J Clin Endocrinol Metab 88:5334–5340PubMedCrossRefGoogle Scholar
  7. 7.
    Wright AD, Hill DM, Lowy C, Fraser TR (1970) Mortality in acromegaly. Q J Med 39:1–16PubMedGoogle Scholar
  8. 8.
    Alexander L, Appleton D, Hall R, Ross WM, Wilkinson R (1980) Epidemiology of acromegaly in the Newcastle region. Clin Endocrinol (Oxf) 12:71–79Google Scholar
  9. 9.
    Bengtsson BA, Eden S, Ernest I, Oden A, Sjögren B (1988) Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Med Scand 223:327–335PubMedCrossRefGoogle Scholar
  10. 10.
    Holdaway IM, Rajasoorya RC, Gamble GD (2004) Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89:667–674PubMedCrossRefGoogle Scholar
  11. 11.
    Littley MD, Shalet SM, Swindell R, Beardwell CG, Sutton ML (1990) Low-dose pituitary irradiation for acromegaly. Clin Endocrinol (Oxf) 32:261–270Google Scholar
  12. 12.
    Jenkins D, O’Brien I, Johnson A, Shakespear R, Sheppard MC, Stewart PM (1995) The Birmingham pituitary database: auditing the outcome of the treatment of acromegaly. Clin Endocrinol (Oxf) 43:517–522Google Scholar
  13. 13.
    Jenkins PJ, Bates P, Carson MN, Stewart PM, Wass JA (2006) Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly. J Clin Endocrinol Metab 91:1239–1245PubMedCrossRefGoogle Scholar
  14. 14.
    Speirs CJ, Reed PI, Morrison R, Aber V, Joplin GF (1990) The effectiveness of external beam radiotherapy for acromegaly is not affected by previous pituitary ablative treatments. Acta Endocrinologica 122:559–565PubMedGoogle Scholar
  15. 15.
    Sheehan JP, Jagannathan J, Pouratian N, Steiner L (2006) Stereotactic radiosurgery for pituitary adenomas: a review of the literature and our experience. Front Horm Res 34:185–205PubMedGoogle Scholar
  16. 16.
    Gutt B, Wowra B, Alexandrov R, Uhl E, Schaaf L, Stalla GK, Schopohl J (2005) Gamma-knife surgery is effective in normalising plasma insulin-like growth factor I in patients with acromegaly. Exp Clin Endocrinol Diabetes 113:219–224PubMedCrossRefGoogle Scholar
  17. 17.
    Laws ER, Sheehan JP, Sheehan JM, Jagnathan J, Jane JAJ, Oskouian R (2004) Stereotactic radiosurgery for pituitary adenomas: a review of the literature. J Neurooncol 69:257–272PubMedCrossRefGoogle Scholar
  18. 18.
    Jezkova J, Marek J, Hana V, Krsek M, Weiss V, Vladyka V, Lisak R, Vymazal J, Pecen L (2006) Gamma knife radiosurgery for acromegaly–long-term experience. Clin Endocrinol (Oxf) 64:588–595CrossRefGoogle Scholar
  19. 19.
    Barkan AL, Halasz I, Dornfeld KJ, Jaffe CA, Friberg RD, Chandler WF Sandler HM (1997) Pituitary irradiation is ineffective in normalizing plasma insulin-like growth factor I in patients with acromegaly. J Clin Endocrinol Metab 82:3187–3191PubMedCrossRefGoogle Scholar
  20. 20.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (1998) Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 88:1002–1008PubMedCrossRefGoogle Scholar
  21. 21.
    Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, Wellis G (2000) Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 85:1287–1289PubMedCrossRefGoogle Scholar
  22. 22.
    Castinetti F, Taieb D, Kuhn JM, Chanson P, Tamura M, Jaquet P, Conte-Devolx B, Regis J, Dufour H, Brue T (2005) Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab 90:4483–4488PubMedCrossRefGoogle Scholar
  23. 23.
    Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC (1993) Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 27:215–221PubMedGoogle Scholar
  24. 24.
    Girkin CA, Comey CH, Lunsford LD, Goodman ML, Kline LB (1997) Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology 104:1634–1643PubMedGoogle Scholar
  25. 25.
    Dowsett RJ, Fowble B, Sergott RC, Savino PJ, Bosley TM, Snyder PJ, Gennarelli TA (1990) Results of radiotherapy in the treatment of acromegaly: lack of ophthalmologic complications. Int J Radiat Oncol Biol Phys 19:453–459PubMedGoogle Scholar
  26. 26.
    Movsas B, Movsas TZ, Steinberg SM, Okunieff P (1995) Long-term visual changes following pituitary irradiation. Int J Radiat Oncol Biol Phys 33:599–605PubMedCrossRefGoogle Scholar
  27. 27.
    Bhansali A, Banerjee AK, Chanda A, Singh P, Sharma SC, Mathuriya SN, Dash RJ (2004) Radiation-induced brain disorders in patients with pituitary tumors Australas Radiol 48:339–346Google Scholar
  28. 28.
    Jones B, Samarasekara S, Tan LT, Mayles WP (1996) The influence of air cavities on the optic chiasm dose during pituitary radiotherapy for acromegaly. Br J Radiol 69:723–725PubMedCrossRefGoogle Scholar
  29. 29.
    Erfurth EM, Bulow B, Mikoczy Z, Svahn-Tapper G, Hagmar L (2001) Is there an increase in second brain tumors after surgery and irradiation for a pituitary tumour? Clin Endocrinol (Oxf) 55:613–616CrossRefGoogle Scholar
  30. 30.
    Bliss P, Kerr GR, Gregor A (1994) Incidence of second brain tumours after pituitary irradiation in Edinburgh 1962–1990. Clin Oncol (R Coll Radiol) 6:361–363Google Scholar
  31. 31.
    Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D (1992) Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. Br Med J 304:1343–1346CrossRefGoogle Scholar
  32. 32.
    Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ (1994) Radiation therapy for pituitary adenoma: treatment outcome and prognostic factors. Int J Radiat Oncol Biol Phys 30:557–565PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Raquel S. Jallad
    • 1
  • Nina R. Musolino
    • 1
  • Luiz R. Salgado
    • 1
  • Marcello D. Bronstein
    • 1
  1. 1.Hosp. Das Clin./Univ. Sao PaoloSao PaoloBrazil

Personalised recommendations