Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 
patients from the German Acromegaly Registry

Knappe, U. J.; Petroff, D.; Ouinkler, M.; Schmid, S. M.; Schoefl, C.; Schopohl, J.; Stieg, M. R.; Toenjes, A.

doi:10.1530/EJE-19-0784

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Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry

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Stieg, M. R.
Max Planck Institute of Psychiatry, Max Planck Society;

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Citation

Knappe, U. J., Petroff, D., Ouinkler, M., Schmid, S. M., Schoefl, C., Schopohl, J., et al. (2020). Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. EUROPEAN JOURNAL OF ENDOCRINOLOGY, 182(3), 275-284. doi:10.1530/EJE-19-0784.

Cite as: https://hdl.handle.net/21.11116/0000-0008-C737-A

Abstract

Background: If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated.
Objective: To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function.
Design and methods: A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0-45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication.
Results: Time between radiotherapy and last follow-up was 13.0 +/- 8.2 years for FRT (n = 233) and 8.9 +/- 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9-16.2) ng/mL for FRT and 3.5 (1.8-6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is -18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30-1.00, P = 0.049) in SRS compared to FRT patients.
Conclusion: Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.