Role of biological effective dose for prediction of endocrine remission in acromegaly patients treated with stereotactic radiosurgery
Authors' conclusion
BED is a strong predictor of endocrine remission in patients treated with SRS. Dose planning and optimization of the BED to > 170Gy2.47 give a greater probability of endocrine remission in acromegalic patients.
Study context
- Population
- Acromegaly patients with GH-secreting pituitary adenomas treated with single-fraction stereotactic radiosurgery (SRS), with available endocrine follow-up; 53.7% male, median age 46.8 years (IQR 21.2)
- Participants
- 67 patients
- Outcome
- Endocrine remission; BED as predictor of SRS outcome
Methodological detailssingle-centre, Median dose 25 Gy (IQR 5); median biological effective dose (BED) 171.9Gy2.47 (IQR 66.0), 5 (7.5%) treated without stopping antisecretory medication
- Single-centre
- Median dose 25 Gy (IQR 5); median BED 171.9Gy2.47 (IQR 66.0)
- 5 (7.5%) treated without stopping antisecretory medication
Main finding
As reported in the abstract
Endocrine remission
- Cumulative probability of maintained endocrine remission off suppressive medications at 3 years
- 62.5% [47.9-73.0]
- Cumulative probability of maintained endocrine remission off suppressive medications at 5 years
- 76.5% [61.0-85.9]
- IGF1i > 1.5 predictor of treatment failure (model 1)
- HR 0.40 (0.21-0.79), p = 0.00783
- Margin dose > 22 Gy associated with endocrine remission
- HR 2.33 (1.06-5.13), p = 0.03593
- BED > 170Gy2.47 associated with endocrine remission
- HR 2.02 (1.06-3.86), p = 0.03370
Observational data: associations, not effects.
Safety
New hypopituitarism after SRS
- Cumulative probability at 3 years
- 36.8% (CI 95% 22.4-45.9)
- Cumulative probability at 5 years
- 53.2% (CI 95% 35.6-66)
- BED or margin dose not associated with new hypopituitarism
Original publication
Role of biological effective dose for prediction of endocrine remission in acromegaly patients treated with stereotactic radiosurgery. Pituitary. Published 5 December 2022. doi:10.
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