Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Neurosurgery. 2019 Jul 1;85(1):E20-E30. doi: 10.1093/neuros/nyy410.
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.
To evaluate the efficacy and safety of low-dose (<25 Gy) GKRS in the treatment of patients with acromegaly.
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.
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.
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.
缓解率与伽玛刀放射外科（GKRS；伽玛刀：瑞典斯德哥尔摩 Elekta AB）治疗肢端肥大症的更高剂量相关，但当功能性腺瘤靠近视器时，剂量≥25Gy 并不总是可行的。
评估低剂量（<25Gy）GKRS 治疗肢端肥大症患者的疗效和安全性。
对 1994 年 6 月至 2016 年 12 月期间接受 GKRS 治疗的肢端肥大症病例进行单中心回顾性研究。共选择 76 例诊断为肢端肥大症且接受低剂量 GKRS 治疗的患者纳入本研究。患者接受的中位边缘剂量、等剂量线和治疗体积分别为 15.8Gy、57.5%和 4.8mL。任何可识别的视器部分的放射剂量限制在 10Gy。所有患者在 GKRS 治疗前后均接受了全面的内分泌、眼科和影像学评估，对结果进行了分析。
33 例（43.4%）患者达到生化缓解。4、8 和 12 年时的累计缓解率分别为 20.3%、49.9%和 76.3%。无海绵窦侵犯（P=0.042）和较低的基线胰岛素样生长因子-1水平（P=0.019）是缓解的显著预测因素。9 例（11.8%）患者出现新的激素缺乏。4、8 和 10 年时的累计激素缺乏率分别为 3%、14%和 22.2%。2 例（2.6%）初始缓解的患者复发。未发生视器并发症。
低剂量 GKRS 治疗肢端肥大症可获得合理的缓解率和新的激素缺乏率，其结果可能与标准 GKRS 边缘剂量相当。
