Fractionated stereotactic radiotherapy: an interesting alternative to stereotactic radiosurgery in acromegaly
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EDITORIAL
Fractionated stereotactic radiotherapy: an interesting alternative to stereotactic radiosurgery in acromegaly Emmanuelle Kuhn1,2,3 • Philippe Chanson1,2,3
Received: 23 September 2015 / Accepted: 30 September 2015 / Published online: 13 October 2015 Ó Springer Science+Business Media New York 2015
To the Editor, Although it is almost always due to a benign tumor, acromegaly remains a severe disease responsible for disabling symptoms, comorbidities, and shortened lifespan if left untreated [1]. Neurosurgery is a very effective first-line treatment for pituitary microadenomas (\10 mm), generally inducing remission [2]. In contrast, transsphenoidal neurosurgery is less effective for macroadenomas, particularly when invasive, which is the case of most patients with acromegaly. Somatostatin analogs, dopamine agonists, and/or a GH receptor antagonist can improve postsurgical disease control in such patients [3], but medical treatment has several drawbacks. In particular, it is expensive and necessitates lifelong injections. In addition, these drugs are not fully effective, even when used in combination, and their use is sometimes limited by severe and persistent adverse effects. Thus, in a number of cases, particularly when the stepwise approach based on surgery and medical therapy fails to control acromegaly, when drug tolerance is poor, and/or when the patient is weary of potentially lifelong medical treatment, it is legitimate to propose radiotherapy [4].
& Philippe Chanson [email protected] 1
Service d’Endocrinologie et des Maladies de la Reproduction, Assistance Publique-Hoˆpitaux de Paris, Hoˆpital de Biceˆtre, 94275 Le Kremlin-Biceˆtre, France
2
Unite´ Mixte de Recherche-S1185, Univ Paris-Sud, Universite´ Paris Saclay, Faculte´ de Me´decine Paris-Sud, 94276 Le Kremlin Biceˆtre, France
3
Unite´ 1185, Institut National de la Sante´ et de la Recherche Me´dicale, 94276 Le Kremlin Biceˆtre, France
Radiotherapy techniques have evolved over the last 20 years. Radiation can be delivered either in a single session by stereotactic radiosurgery (SRS), or fractionated during multiple sessions. Radiosurgery, performed in a single session after 3D localization of the culprit lesion, induces remission in a large proportion of patients with small adenoma remnants distant from the optic chiasm [5]. Various SRS modalities are available, and radiation can be delivered either as photons (Gamma Knife, Linac, CyberKnife) or charged particles (protons). SRS is used to deliver 20–25 Gy in one or a few sessions. However, radiosurgery is unsuitable for patients with large invasive tumors or even small adenomas close the optic nerves or chiasm [6, 7]. Alongside ‘‘conventional’’ fractionated radiotherapy, new radiotherapy techniques have been developed with the aim of reducing irradiation of healthy brain tissue surrounding the tumor. Fractionated stereotactic radiotherapy (FSRT) is a hybrid modality which, as its name implies, combines stereotactic localization with fractionated therapy, administered as 3D-conform
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