• Fu-Yuan Pai, Ching-Jen Chen, Wen-Hsin Wang, Huai-Che Yang, Chung Jung Lin, Hsiu-Mei Wu, Yi-Chun Lin, Harn-Shen Chen, Yu-Shu Yen, Wen-Yuh Chung, Wan-Yuo Guo, David Hung-Chi Pan, Cheng-Ying Shiau, and Cheng-Chia Lee.
• Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.
• Neurosurgery. 2019 Jul 1; 85 (1): E20-E30.

BackgroundRemission rate is associated with higher dose of Gamma Knife Radiosurgery (GKRS; Gamma Knife: Elekta AB, Stockholm, Sweden) for acromegaly, but the dose ≥25 Gy is not always feasible when the functioning adenoma is close to optic apparatus.ObjectiveTo evaluate the efficacy and safety of low-dose (<25 Gy) GKRS in the treatment of patients with acromegaly.MethodsSingle-center retrospective review of acromegaly cases treated with GKRS between June 1994 and December 2016. A total of 76 patients with the diagnosis of acromegaly who were treated with low-dose GKRS were selected for inclusion. Patients were treated with a median margin dose, isodose line, and treatment volume of 15.8 Gy, 57.5%, and 4.8 mL, respectively. Any identifiable portion of the optic apparatus was limited to a radiation dose of 10 Gy. All patients underwent full endocrine, ophthalmological, and imaging evaluation prior to and after GKRS treatments, and results of these were analyzed.ResultsBiochemical remission was achieved in 33 (43.4%) patients. Actuarial remission rates were 20.3%, 49.9%, and 76.3% at 4, 8, and 12 yr, respectively. Absence of cavernous sinus invasion (P = .042) and lower baseline insulin-like growth factor-1 levels (P = .019) were significant predictors of remission. New hormone deficiencies were found in 9 (11.8%) patients. Actuarial hormone deficiency rates were 3%, 14%, and 22.2% at 4, 8, and 10 yr, respectively. Two (2.6%) patients who achieved initial remission experienced recurrence. No optic complications were encountered.ConclusionReasonable remission and new hormone deficiency rates can be achieved with low-dose GKRS for acromegaly. These rates may be comparable to those with standard GKRS margin doses.Copyright © 2018 by the Congress of Neurological Surgeons.

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