Περίληψη:
Radiotherapy (RT) has long been used in the treatment of acromegaly, but
confusion regarding the definition of biochemical cure has hampered
interpretation of previous reports on the outcome of this treatment. In
the present study we present additional data using the currently
accepted criteria of biochemical cure in a large group of patients
followed up by our department. Forty-six acromegalic patients were
treated with external beam megavoltage RT and followed up for a mean of
7.6 years (range 2-22 years). Only four patients had had previous
surgical treatment by either transsphenoidal or transfrontal routes.
Following RT, mean basal GH levels decreased from 30.9 ng/ml (5-96
ng/ml) to 11.5 ng/ml (1-36 ng/ml) at 10 years of follow up with a
further fall to 6.1 ng/ml (1-29 ng/ml) in those patients followed up for
more than 10 years. As a result, although mean GH levels of less than 5
ng/ml were achieved in 9/28 (30.1%) at 5 years, 6/19 (31.6%) at 10
years, and in 6/11 (54.5%) of those patients followed up for more than
10 years post-RT, only 0/28 (0%), 7/28 (25%), 4/19 (21%) and 1/11
(1%) achieved GH levels of 12.5 ng/ml at 2, 5, 10 and >10 years
following RT. Thus, in the whole series only 10/48 (20.8%) patients
showed a decrease of GH level to less than 2.5 ng/ml at their latest
follow up. Hypopituitarism as a result of RT was only infrequently
observed in this series; gonadal deficiency developed in 12 (26.6%)
patients, thyrotrophin (TSH) deficiency in 3 (6.6%) and
adrenocorticotrophin deficiency in 2 (4.4%). In conclusion, megavoltage
RT is an effective treatment for the control of GH hypersecretion in
acromegaly, with a continuing lowering effect for several years
following RT, but seldom leads to safe GH levels.
Συγγραφείς:
Thalassinos, NC
Tsagarakis, S
Ioannides, G
Tzavara, I and
Papavasiliou, C
