Low-Dose Gamma Knife Radiosurgery for Acromegaly

Fu Yuan Pai, Ching Jen Chen, Wen Hsin Wang, Huai Che Yang, Chung Jung Lin, Hsiu Mei Wu, Yi Chun Lin, Harn Shen Chen, Yu Shu Yen, Wen Yuh Chung, Wan Yuo Guo, David Hung Chi Pan, Cheng Ying Shiau, Cheng Chia Lee

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Background: Remission rate is associated with higher dose of Gamma Knife Radiosurgery (GKRS; Gamma Knife: Elekta AB, Stockholm, Sweden) for acromegaly, but the dose ≥25 Gy is not always feasible when the functioning adenoma is close to optic apparatus Objective: To evaluate the efficacy and safety of low-dose (<25 Gy) GKRS in the treatment of patients with acromegaly. Methods: Single-center retrospective review of acromegaly cases treated with GKRS between June 1994 and December 2016. A total of 76 patients with the diagnosis of acromegaly who were treated with low-dose GKRS were selected for inclusion. Patients were treated with a median margin dose, isodose line, and treatment volume of 15.8 Gy, 57.5%, and 4.8 mL, respectively. Any identifiable portion of the optic apparatus was limited to a radiation dose of 10 Gy. All patients underwent full endocrine, ophthalmological, and imaging evaluation prior to and after GKRS treatments, and results of these were analyzed. Results: Biochemical remission was achieved in 33 (43.4%) patients. Actuarial remission rates were 20.3%, 49.9%, and 76.3% at 4, 8, and 12 yr, respectively. Absence of cavernous sinus invasion (P =. 042) and lower baseline insulin-like growth factor-1 levels (P =. 019) were significant predictors of remission. New hormone deficiencies were found in 9 (11.8%) patients. Actuarial hormone deficiency rates were 3%, 14%, and 22.2% at 4, 8, and 10 yr, respectively. Two (2.6%) patients who achieved initial remission experienced recurrence. No optic complications were encountered. CONCLUSION: Reasonable remission and new hormone deficiency rates can be achieved with low-dose GKRS for acromegaly. These rates may be comparable to those with standard GKRS margin doses.

Original languageEnglish
Article numbernyy410
Pages (from-to)E20-E30
JournalClinical Neurosurgery
Volume85
Issue number1
DOIs
Publication statusPublished - Jul 1 2019

Keywords

  • Acromegaly
  • Gamma-knife
  • Low dose
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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