A systematic analysis of disease control in acromegaly treated with radiosurgery

Object. Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone-secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly. Methods. A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication. Results. The overall disease control rate without medication was 48%-53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 +/- 25.8 months. The mean overall tumor volume in this analysis was 2.11 +/- 1.16 cm(3). The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546). Conclusions. Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly. (DOI: 10.3171/2010.7.FOCUS10170)