Outcome of Surgery and Radiotherapy in Acromegaly / 대한내분비학회지

ABSTRACT

BACKGROUND: The primary goal of therapy for acmmegaly is to reduce excess growth hormone (GH) secretion through surgical excision of pituitary adenoma and, in patients with large tumors, to debulk tumor mass and decompress adjacent structures. For the patients in whom surgery is contraindicated or has failed, radiotherapy should be considered. However, there was no analysis of the outcome folIowing the treatment of acromegly in Korea. METHODS: We retrospectively reviewed 128 patients who underwent surgical excision or radiotherapy for acromegaly and followed at our hospital between January 1980 and July 1997 to investigate the outcome of surgny and radiotherapy for acromegaly and to analyze preoperative and preradiotherapeutic parameters that predict a successful outcome of therapy. RESULTS: Pituitary adenomectomy was underwent to the 113 patients with acromegaly, then 33.6% of them showed basa1 GH levels below 5 ug/L and basal GH levels were dropped below 2.5 ug/L in 22.1% of the 113 patients. Postoperative basal GH levels were significantly correlated with preoperative tumor size(r=0.54, p<0.05) and preoperative GH levels(r=0.44, p<0.05). A successful outcome of surgery was influenced by preoperative tumor size, preoperative GH level and extrasellar extension. Multivariate analysis indicated that preoperative tumor size was an independent significant factor affecting the postoperative outcome(OR=2.19, p<0.05). After radiotherapy, the median years of decrease GH<10ug/L and <5ug/L were 3.7 and 7.8, respectively and GH levels of <5ug/L occurred in 35 percent of the patients at 5 years and in 56 percent at 10 yeats. The outcome of radiotherapy depends on the GH levels in preradiotherapy. CONCLUSION: The most reliable prognostic preoperative parameter of successful outcome of surgery was preoperative tumor size and the rate of fall in serum GH after radiotherapy is comparable to the preradiotherapy GH levels in our study, so that early diagnosis and proper treatment can improve the outcome of therapy in the patients with acromegaly. In the cases of large GH-secreting pituitary adenoma, it is required a combination of surgery and radiotherapy to achieve maximal suppresssion of GH levels before radiotherapy.