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Assessment of Multimodal Treatment Options in Recurrent and Persistent Acromegaly: A Systematic Review and Meta-Analysis Publisher Pubmed



Maroufi SF1, 2 ; Assar M3 ; Khorasanizadeh M4 ; Sabet FM1 ; Sabahi M5 ; Dabecco R5 ; Adada B5 ; Zada G6 ; Borgheirazavi H5, 7
Authors
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Authors Affiliations
  1. 1. Neurosurgery Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
  2. 2. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Surgery, University of Florida, Jacksonville, FL, United States
  4. 4. Department of Neurosurgery, Mount Sinai Hospital, Icahn School of Medicine, New York City, NY, United States
  5. 5. Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, FL, United States
  6. 6. Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
  7. 7. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 2950 Cleveland Clinic Blvd., Weston, 33331, FL, United States

Source: Journal of Neuro-Oncology Published:2024


Abstract

Purpose: In patients with acromegaly, secondary treatment options in cases of hormonal non-remission or tumor progression include repeat transsphenoidal surgery (TSS), radiation-based treatment (RT), or medical therapy (MT). In this study, we aim to evaluate the clinical effectiveness of various second-line treatment options for acromegaly. Methods: Using the PRISMA guideline, a systematic review was performed by searching MEDLINE (PubMed), Web of Science, Scopus, and Cochrane electronic bibliographic databases from conception to the end of 2022. Outcomes of interest included hormonal remission rate, complications, and mortality associated with each treatment modality for refractory acromegaly. Results: A total of 79 studies including 3,208 refractory acromegaly patients (44.90% males) were analyzed, with a mean patient age of 43.89 years. There was a statistically significant difference between various therapeutic modalities in terms of remission rate, with MT offering the highest remission rate (62.55%), followed by RT (50.15%) and TSS (37.39%). Subgroup analysis of radiotherapeutic and medical modalities did not show a significant difference in remission rate between different kinds of sub-modalities in each treatment approach. Recurrence following secondary treatment was not different in patients treated with reoperation TSS compared to other modalities. Conclusions: The management of persistent and recurrent acromegaly optimally requires a multimodal approach. In different scenarios of refractory acromegaly based on previous treatment, secondary treatments may vary in terms of remission rate and complications. Medical agents provide considerable effectiveness as a second-line therapy for recurrent or persistent disease. In selected cases, however, reoperation still provides an opportunity for cure or freedom from medications. The findings of this study may help clinicians to prioritize varying options involved in this multifaceted decision-making process. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
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1. Recurrent Acromegaly: A Systematic Review on Therapeutic Approaches, BMC Endocrine Disorders (2024)