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Abu Dabrh A, Asi N, Farah W, et al. Radiotherapy vs. Radiosurgery in Treating Patients with Acromegaly: Systematic Review and Meta-Analysis. Endocr Pract. 2015;1-33doi: 10.4158/EP14574.RA.
Abu Dabrh, A., Asi, N., Farah, W., Mohammed, K., Wang, Z., Farah, M., Prokop, L., Katznelson, L., & Murad, M. (2015). Radiotherapy vs. Radiosurgery in Treating Patients with Acromegaly: Systematic Review and Meta-Analysis. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 1-33. https://doi.org/10.4158/EP14574.RA
Abu Dabrh, Abd, et al. "Radiotherapy vs. Radiosurgery in Treating Patients with Acromegaly: Systematic Review and Meta-Analysis." Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists vol. (2015): 1-33. doi: https://doi.org/10.4158/EP14574.RA
Abu Dabrh A, Asi N, Farah W, Mohammed K, Wang Z, Farah M, Prokop L, Katznelson L, Murad M. Radiotherapy vs. Radiosurgery in Treating Patients with Acromegaly: Systematic Review and Meta-Analysis. Endocr Pract. 2015 Mar 18;1-33. doi: 10.4158/EP14574.RA. Epub 2015 Mar 18. PMID: 25786558.
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Endocr Pract. 2015 Mar 18;1-33. doi: 10.4158/EP14574.RA. Epub 2015 Mar 18.

Radiotherapy vs. Radiosurgery in Treating Patients with Acromegaly: Systematic Review and Meta-Analysis.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

Abd Abu Dabrh, Noor Asi, Wigdan Farah, Khaled Mohammed, Zhen Wang, Magdoleen Farah, Larry Prokop, Laurence Katznelson, Mohammad Murad

Affiliations

  1. 1 Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN, USA.

PMID: 25786558 DOI: 10.4158/EP14574.RA

Abstract

OBJECTIVE: When patients with acromegaly have residual disease following surgery, adjuvant radiation therapy is considered. Both stereotactic radiosurgery (SRS) and conventional fractionated radiotherapy (RT) are utilized. We conducted a systematic review and meta-analysis to synthesize the existing evidence to compare outcomes with SRS and RT in patients with acromegaly.

METHODS: We searched Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through April 2014 for studies in which SRS or RT were used in patients with acromegaly. Outcomes evaluated were serum IGF-1 and GH levels, biochemical remission, all-cause mortality, hypopituitarism, headaches and secondary malignancies. We pooled outcomes using the random-effects model.

RESULTS: The final search yielded 30 eligible studies enrolling 2464 patients. When compared to RT, SRS was associated with a non-significant increase in remission rate at the latest follow-up period (52% vs. 36%; p = 0.14), and a significantly lower follow-up IGF-1 level (decline of - 409.72 μg/1 vs. -102 μg/1; p = 0.002). SRS was associated with lower incidence of hypopituitarism than RT; however the difference was not statistically significant [(32% vs.51%, respectively; p = 0.05).

CONCLUSIONS: SRS may be associated with better biochemical remission and lower risk of hypopituitarism with at least one deficient axis when compared with RT; however, the confidence in such evidence is very low due to the non-comparative nature of the studies, high heterogeneity, and imprecision.

Keywords: Acromegaly; IGF-1; adenoma; growth hormone; radiosurgery; radiotherapy

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