Neurosurgery Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
J Neurooncol. 2024 May;168(1):13-25. doi: 10.1007/s11060-024-04658-7. Epub 2024 Apr 8.
In patients with acromegaly, secondary treatment options in cases of hormonal non-remission or tumor progression include repeat transsphenoidal surgery (TSS), radiation-based treatment (RT), or medical therapy (MT). In this study, we aim to evaluate the clinical effectiveness of various second-line treatment options for acromegaly.
Using the PRISMA guideline, a systematic review was performed by searching MEDLINE (PubMed), Web of Science, Scopus, and Cochrane electronic bibliographic databases from conception to the end of 2022. Outcomes of interest included hormonal remission rate, complications, and mortality associated with each treatment modality for refractory acromegaly.
A total of 79 studies including 3,208 refractory acromegaly patients (44.90% males) were analyzed, with a mean patient age of 43.89 years. There was a statistically significant difference between various therapeutic modalities in terms of remission rate, with MT offering the highest remission rate (62.55%), followed by RT (50.15%) and TSS (37.39%). Subgroup analysis of radiotherapeutic and medical modalities did not show a significant difference in remission rate between different kinds of sub-modalities in each treatment approach. Recurrence following secondary treatment was not different in patients treated with reoperation TSS compared to other modalities.
The management of persistent and recurrent acromegaly optimally requires a multimodal approach. In different scenarios of refractory acromegaly based on previous treatment, secondary treatments may vary in terms of remission rate and complications. Medical agents provide considerable effectiveness as a second-line therapy for recurrent or persistent disease. In selected cases, however, reoperation still provides an opportunity for cure or freedom from medications. The findings of this study may help clinicians to prioritize varying options involved in this multifaceted decision-making process.
在肢端肥大症患者中，激素未缓解或肿瘤进展的二线治疗选择包括重复经蝶窦手术（TSS）、基于放射治疗（RT）或药物治疗（MT）。本研究旨在评估各种二线治疗肢端肥大症的临床疗效。
使用 PRISMA 指南，通过检索 MEDLINE（PubMed）、Web of Science、Scopus 和 Cochrane 电子文献数据库，从概念到 2022 年底进行了系统评价。感兴趣的结局包括每种难治性肢端肥大症治疗方法的激素缓解率、并发症和死亡率。
共分析了 79 项研究，包括 3208 例难治性肢端肥大症患者（44.90%为男性），患者平均年龄为 43.89 岁。各种治疗方法在缓解率方面存在统计学差异，MT 的缓解率最高（62.55%），其次是 RT（50.15%）和 TSS（37.39%）。放射治疗和药物治疗的亚组分析显示，每种治疗方法中不同亚类的缓解率没有显著差异。与其他治疗方法相比，再次接受 TSS 手术治疗的患者在二次治疗后的复发率没有差异。
持续性和复发性肢端肥大症的治疗最佳需要采用多模式方法。在基于既往治疗的难治性肢端肥大症不同情况下，二线治疗在缓解率和并发症方面可能有所不同。药物治疗作为复发性或持续性疾病的二线治疗具有相当大的疗效。然而，在某些情况下，再次手术仍有治愈或摆脱药物的机会。本研究的结果可能有助于临床医生在这一多方面决策过程中优先考虑不同的选择。
