ArticleNeurosurgery2020
The Impact of Insulin-Like Growth Factor Index and Biologically Effective Dose on Outcomes After Stereotactic Radiosurgery for Acromegaly: Cohort Study.
Article in Neurosurgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Single fraction and hypofractionated radiosurgery for perioptic meningiomas-tumor control and visual outcomes: a systematic review and meta-analysis.Neurosurgical review · 2023Pooled it
- Can acromegaly be controlled in all cases?Journal of neuroendocrinology · 2026Review
- Loss of pituitary hormone function after stereotactic radiosurgery for pituitary adenomas: mechanisms and management.Journal of neuro-oncology · 2026Review
- The Role of Biological Effective Dose in Gamma Knife Radiosurgery: A Systematic Review Across Multiple Indications.Journal of clinical medicine · 2026Review
- Pitch Perfect: Clinical Research Primer on the Art of Pitching Projects for Medical Students.Journal of neurological surgery reports · 2026Article
- Multidisciplinary management of pituitary macroadenoma.World journal of methodology · 2025Article
- Article
- Acromegaly: diagnostic challenges and individualized treatment.Expert review of endocrinology & metabolism · 2025Review
- Gamma knife radiosurgery for cerebral cavernous malformations: biologically effective dose predicts therapeutic outcomes.Frontiers in neurology · 2025Article
- Biological effective dose as a predictor of local tumor control in stereotactic radiosurgery treated parasellar meningioma patients.Journal of neuro-oncology · 2024Article
- Zap-X Radiosurgery System: Initial Clinical Experience in a Recurrent Gamma Knife Case Series.Cureus · 2024Article
- Impact of biologically effective dose on tremor decrease after stereotactic radiosurgical thalamotomy for essential tremor: a retrospective longitudinal analysis.Neurosurgical review · 2024Article
- Article
- Efficiency and Safety of CyberKnife Robotic Radiosurgery in the Multimodal Management of Patients with Acromegaly.Cancers · 2023Article
- Toward semi-automatic biologically effective dose treatment plan optimisation for Gamma Knife radiosurgery.Physics in medicine and biology · 2022Article
- Approach to the Patient With Treatment-resistant Acromegaly.The Journal of clinical endocrinology and metabolism · 2022Article
- Modern Linear Accelerator-Based Radiotherapy Is Safe and Effective in the Treatment of Secretory and Nonsecretory Pituitary Adenomas.World neurosurgery · 2022Article
- Jacob I. Fabrikant Award lectureJournal of radiosurgery and SBRT · 2022Article
- Gamma Knife radiosurgery for trigeminal neuralgia provides greater pain relief at higher dose rates.Journal of radiosurgery and SBRT · 2022Article
- Biologically effective dose correlates with linear tumor volume changes after upfront single-fraction stereotactic radiosurgery for vestibular schwannomas.Neurosurgical review · 2021Article
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8 authors.
Funding
Abstract
backgroundStereotactic radiosurgery (SRS) is a safe and effective treatment for acromegaly.
objectiveTo improve understanding of clinical and dosimetric factors predicting biochemical remission.
methodsA single-institution cohort study of nonsyndromic, radiation-naïve patients with growth hormone-producing pituitary adenomas (GHA) having single-fraction SRS between 1990 and 2017. Exclusions were treatment with pituitary suppressive medications at the time of SRS, or <24 mo of follow-up. The primary outcome was biochemical remission-defined as normalization of insulin-like growth factor-1 index (IGF-1i) off suppression. Biochemical remission was assessed using Cox proportional hazards. Prior studies reporting IGF-1i were assessed via systematic literature review and meta-analysis using random-effect modeling.
resultsA total of 102 patients met study criteria. Of these, 46 patients (45%) were female. The median age was 49 yr (interquartile range [IQR] = 37-59), and the median follow-up was 63 mo (IQR = 29-100). The median pre-SRS IGF-1i was 1.66 (IQR = 1.37-3.22). The median margin dose was 25 Gy (IQR = 21-25); the median estimated biologically effective dose (BED) was 169.49 Gy (IQR = 124.95-196.00). Biochemical remission was achieved in 58 patients (57%), whereas 22 patients (22%) had medication-controlled disease. Pre-SRS IGF-1i ≥ 2.25 was the strongest predictor of treatment failure, with an unadjusted hazard ratio (HR) of 0.51 (95% CI = 0.26-0.91, P = .02). Number of isocenters, margin dose, and BED predicted remission on univariate analysis, but after adjusting for sex and baseline IGF-1i, only BED remained significant-and was independently associated with outcome in continuous (HR = 1.01, 95% CI = 1.00-1.01, P = .02) and binary models (HR = 2.27, 95% CI = 1.39-5.22, P = .002). A total of 24 patients (29%) developed new post-SRS hypopituitarism. Pooled HR for biochemical remission given subthreshold IGF-1i was 2.25 (95% CI = 1.33-3.16, P < .0001).
conclusionIGF-1i is a reliable predictor of biochemical remission after SRS. BED appears to predict biochemical outcome more reliably than radiation dose, but confirmatory study is needed.
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