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Gamma knife stereotactic radiosurgery for acromegaly

¹ Department of Neurosurgery, ² Section for Endocrinology, Department of Medicine,³ Department of Ophthalmology,⁴ Centre for Clinical Research and Haukeland University Hospital, Bergen, Norway, ⁵ Institute of Surgery ⁶ Institute of Medicine, ⁷ Department of Clinical Medicine and ⁸ Department of Biomedicine, University of Bergen, Bergen, Norway and ⁹ Department of Endocrinology, Internal Medicine, Norwegian National Hospital, Oslo, Norway

(Correspondence should be addressed to E O Vik-Mo who is now at Department of Neurosurgery, Ulleval University Hospital, Oslo, Norway and Vilhelm Magnus Center for Neurosurgical Research, Institute for Surgical Research, Norwegian National Hospital, Oslo, Norway; Email: e.o.vik-mo{at}medisin.uio.no)

Background: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion.

Objective: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment.

Design: Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation.

Setting: Norwegian National Center for gamma knife treatment.

Patients: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up.

Results: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period.

Conclusion: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.