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J Neurol Surg B Skull Base
DOI: 10.1055/a-2693-1815
Original Article

LINAC-based Stereotactic Radiotherapy for Acromegaly: A Single-center Retrospective Cohort

Geovanne P. Mauro 
1   Department of Radiology and Oncology – Discipline of Radiotherapy, Faculdade de Medicina USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Leila M. Da Róz
2   Department of Neurology – Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Vinicius de Carvalho Gico
3   Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Medical School of Sao Paulo University, Sao Paulo, SP, Brazil
,
Silvio Thiago Pereira Vasconcelos
1   Department of Radiology and Oncology – Discipline of Radiotherapy, Faculdade de Medicina USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Eduardo Weltman
1   Department of Radiology and Oncology – Discipline of Radiotherapy, Faculdade de Medicina USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Evandro C. de Souza
2   Department of Neurology – Discipline of Neurosurgery, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
,
Raquel S. Jallad
4   Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
,
Malebranche Berardo Carneiro da Cunha Neto
4   Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
,
Rosangela C. Villar
1   Department of Radiology and Oncology – Discipline of Radiotherapy, Faculdade de Medicina USP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
› Author Affiliations
Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Our Radiation Oncology Department was granted by the Technical Cooperation Program from the International Atomic Energy Agency (IAEA) funds for renovation of the radiosurgery planning and delivery system in 2010.
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Abstract

Background

Most results for stereotactic radiotherapy (SRT) for acromegaly patients come from Gamma-Knife series. We aim to describe outcomes for LINAC-based SRT, as well as compare results for single-dose (SRS) and fractionated (SFRT) treatments.

Methods

Single-center retrospective cohort in a tertiary, academic hospital assessed between 2008 and 2024.

Results

A total of 48 patients were assessed for outcomes of acromegaly after SRT. Most of them female (62.5%). Mean age was 42.5 years (range 12–73). Median lesion size was 2.1 cm (range 0.2 to 7.2 cm). Among previous deficits, previous hormonal deficits (31.3%) and visual deficits (45.8%) were common. Most patients were diagnosed with pure somatotrophic lesions (87.5%). SRS was done in 16 (33.3%) patients and 32 (66.7%) underwent SFRT. Concurrent octreotide long-acting release (Oct-LAR) (29/60.4%) and cabergoline (20/41.7%) were also common. Median follow-up was 85.3 months (8.2–187.9 months). Tumor control was achieved in 47 (97.9%). Mean progression-free survival (PFS) was 85.3 months (92.4 months for SRS and 81.7 months for SFRT, p = 0.42). Univariate analysis showed no variable impacted overall survival (OS), PFS, new visual, or new hormonal disorders. Hormonal remission was achieved in 22 (45.8%) patients. Median time to hormonal disease control (THC) was 73.1 months for the entire cohort, and 45.8 months for SRS patients and 74.7 months for SFRT patients, with no difference between groups ([HR], 0.30; 95% CI, −1.14 to 0.53; p = 0.47).

Conclusion

We described acromegaly patients treated with LINAC SRS and with the current criteria for hormonal cure. THC was longer for SFRT patients, with no statistical differences. Concurrent treatment did not impact outcomes.

Keywords

pituitary GH hypersecretion - radiosurgery - radiotherapy - stereotactic

Contributors' Statement

G.M. and L.d.R.: responsible for study design; L.d.R.: responsible for ethics committee approval; G.M. and V.G.: responsible for data collection; G.M. and S.V.: wrote the project's final draft; G.M.: responsible for statistical analysis; E.W., E.S., R.J., M.N., and R.V.: responsible for overall orientation and manuscript review.


Data Availability Statement

Data on this research is available on request to the corresponding author.


Ethical Approval

According to the Brazilian law and the Declaration of Helsinki, ethics committee authorization was obtained from the local ethics committee. Due to its retrospective nature, the local ethics committee allowed this research to be conducted without signed patient consent.


Informed Consent

The authors grant the publisher the sole and exclusive license of the full copyright. The authors guarantee that this manuscript has not been previously published elsewhere. The authors declare that any person named as co-author of the contribution is aware of the fact and has agreed to being so named.


Dedication

We dedicate this paper to the work of Dr. Nina Rosa de Castro Musolino (in memoriam).




Publication History

Received: 13 June 2025

Accepted: 29 August 2025

Article published online:
09 September 2025

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