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Outcome of Gamma Knife Radiosurgery in 82 Patients with Acromegaly: Correlation with Initial Hypersecretion

Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition (F.C., D.T., P.J., B.C.-D., T.B.), Department of Neurosurgery and Functional Neurosurgery (M.T., J.R., H.D.), and Department of Neurosurgery (H.D.), Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, 13385 Marseille, France; Department of Endocrinology and Metabolic Diseases (J.-M.K.), Centre Hospitalier Universitaire de Rouen, 76031 Rouen, France; and Department of Endocrinology and Reproductive Diseases (P.C.), Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre and Faculté de Médecine Paris XI, 94270 Le Kremlin Bicêtre, France

Address all correspondence and requests for reprints to: Prof. T. Brue, Department of Endocrinology, Hôpital de la Timone, 264 rue St. Pierre, cedex 5, 13385 Marseille, France. E-mail: thierry.brue{at}mail.ap-hm.fr.

Context: Because surgical and medical therapies of acromegaly all have specific limitations, radiotherapy has been used as an adjunctive strategy. Stereotactic radiosurgery has not yet been widely evaluated.

Objective: The objective was to perform an analysis of long-term hormonal effects and tolerance of gamma knife radiosurgery.

Design: Eighty-two patients were prospectively studied over a decade, with a mean follow-up of 49.5 months.

Setting: All patients were treated at the Department of Functional Neurosurgery of Marseille, France.

Patients: The patients included 82 with active acromegaly, of whom 63 had previous transsphenoidal surgery.

Intervention: Intervention included radiosurgery using the Leksell Gamma Unit B model.

Main Outcome Measures: Remission was diagnosed when mean GH levels were less than 2 ng/ml and IGF-I was normal for age off somatostatin agonists (at least 3 months).

Results: Seventeen percent of the patients were in remission without any treatment. Twenty-three percent previously uncontrolled on somatostatin agonists fulfilled the same criteria after gamma knife while maintained on medical treatment. Initial GH and IGF-I levels off somatostatin agonists were significantly higher in uncured than in remission group (P = 0.01 and 0.047, respectively). Withdrawal of somatostatin agonists at the time of radiosurgery had no incidence on the outcome. No significant difference was found in success rate whether patients had previously been treated or not. Long-term side effects included complete (n = 2) or partial (n = 12) hypopituitarism diagnosed 1–7 yr after gamma knife.

Conclusions: Gamma knife radiosurgery may represent a therapeutic approach in patients with moderate initial or residual GH hypersecretion.

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