|Year : 2021 | Volume
| Issue : 5 | Page : 1500
Commentary on Gamma Knife Surgery Combined with Octreotide Treatment of Acromegaly Patients: A Clinical Curative Effect Analysis
Manish Singh Sharma
Department of Neurosurgery, Mayo Clinic Health System, Mankato, Minnesota, USA
|Date of Web Publication||30-Oct-2021|
Manish Singh Sharma
1025, Marsh Street, Mankato, Minnesota - 56001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma MS. Commentary on Gamma Knife Surgery Combined with Octreotide Treatment of Acromegaly Patients: A Clinical Curative Effect Analysis. Neurol India 2021;69:1500
Liu et al., report on 38 patients with acromegaly, who either did not opt for, or else were not suitable for surgical resection. All of these patients received primary Gamma knife radiosurgery (GKS). 16 of these patients in addition received Octreotide (15 short and a single long acting formulation) for a range of 2-6 months. The decision to start Octreotide was determined by physician preference and this was not influenced by the Gamma Knife team. The rate of biochemical remission was 13.6% in the GKS group and increased to 62.5% in the group that received Octreotide in addition.
There are several factors that affect the interpretation of these results. This is a retrospective study with unestablished protocols. The average tumor size was 821.7 mm. The reasons for not performing surgery, which remains the mainstay of therapy, are not elaborated. Current guidelines do not support the use of primary GKS for patients with acromegaly unless medical therapy is unavailable, unsuccessful, or not tolerated. Yet 16 patients did receive Octreotide. IGF-1 levels were not available for all patients. Two patients did undergo surgery eventually for uncontrolled biochemical levels, which raises the question once again about why surgery was not the initial modality of treatment. Average follow up was limited at 2.9 + 1.3 years. Post treatment radiographic follow up was not available.
Given these limitations, what does appear to be clear is that GKS may be the least effective modality of initial treatment for patients with acromegaly.
| » References|| |
Liu HB, Wang W. Gamma Knife Surgery Combined with Octreotide Treatment of Acromegaly Patients: A Clinical Curative Effect analysis. Neurol India [Epub ahead of print].
Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, et al
. Endocrine Society. Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:3933-51.