Pituitary Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Endocrinology and Diabetes Unit, Department of Medical and Surgical Translational Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Front Endocrinol (Lausanne). 2023 May 3;14:1123267. doi: 10.3389/fendo.2023.1123267. eCollection 2023.
Growth Hormone-secreting adenomas exhibits variable biological behavior and heterogeneous natural history, ranging from small adenomas and mild disease, to invasive and aggressive neoplasms with more severe clinical picture. Patients not cured or controlled after neurosurgical and first-generation somatostatin receptor ligands (SRL) therapy could require multiple surgical, medical and/or radiation treatments to achieve disease control. To date, no clinical, laboratory, histopathological, or neuroradiological markers are able to define the aggressiveness or predict the disease prognosis in patients with acromegaly. Therefore, the management of these patients requires careful evaluation of laboratory assessments, diagnostic criteria, neuroradiology examinations, and neurosurgical approaches to choose an effective and patient-tailored medical therapy. A multidisciplinary approach is particularly useful in difficult/aggressive acromegaly to schedule multimodal treatment, which includes radiation therapy, chemotherapy with temozolomide and other, recent emerging treatments. Herein, we describe the role of the different members of the multidisciplinary team according to our personal experience; a flow-chart for the therapeutic approach of difficult/aggressive acromegaly patients is proposed.
生长激素腺瘤表现出可变的生物学行为和异质的自然史，范围从小腺瘤和轻度疾病到侵袭性和侵袭性肿瘤，具有更严重的临床表现。在神经外科和第一代生长抑素受体配体 (SRL) 治疗后未治愈或未得到控制的患者可能需要多次手术、药物和/或放射治疗来控制疾病。迄今为止，没有临床、实验室、组织病理学或神经影像学标志物能够定义侵袭性或预测肢端肥大症患者的疾病预后。因此，这些患者的管理需要仔细评估实验室评估、诊断标准、神经影像学检查和神经外科方法，以选择有效的、针对患者的药物治疗。多学科方法在治疗困难/侵袭性肢端肥大症时特别有用，以安排多模式治疗，包括放射治疗、替莫唑胺化疗和其他最近出现的治疗方法。在此，我们根据个人经验描述了多学科团队不同成员的作用；提出了一种治疗困难/侵袭性肢端肥大症患者的流程图。
