{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:51:51Z","timestamp":1783774311042,"version":"3.55.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The role of primary stereotactic radiosurgery (SRS) in patients with medically refractory acromegaly who are not operative candidates or who refuse resection is poorly understood. The aim of this multicenter, matched cohort study was to compare the outcomes of primary versus postoperative SRS for acromegaly.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors reviewed an International Radiosurgery Research Foundation database of 398 patients with acromegaly who underwent SRS and categorized them into primary or postoperative cohorts. Patients in the primary SRS cohort were matched, in a 1:2 ratio, to those in the postoperative SRS cohort, and the outcomes of the 2 matched cohorts were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The study cohort comprised 78 patients (median follow-up 66.4 months), including 26 and 52 in the matched primary and postoperative SRS cohorts, respectively. In the primary SRS cohort, the actuarial endocrine remission rates at 2 and 5 years were 20% and 42%, respectively. The Cox proportional hazards model showed that a lower pre-SRS insulin-like growth factor\u20131 level was predictive of initial endocrine remission (p = 0.03), whereas a lower SRS margin dose was predictive of biochemical recurrence after initial remission (p = 0.01). There were no differences in the rates of radiological tumor control (p = 0.34), initial endocrine remission (p = 0.23), biochemical recurrence after initial remission (p = 0.33), recurrence-free survival (p = 0.32), or hypopituitarism (p = 0.67) between the 2 matched cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Primary SRS has a reasonable benefit-to-risk profile for patients with acromegaly in whom resection is not possible, and it has similar outcomes to endocrinologically comparable patients who undergo postoperative SRS. SRS with medical therapy in the latent period can be used as an alternative to surgery in selected patients who cannot or do not wish to undergo resection.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.1.jns183398","type":"journal-article","created":{"date-parts":[[2019,4,27]],"date-time":"2019-04-27T07:20:04Z","timestamp":1556349604000},"page":"1507-1516","source":"Crossref","is-referenced-by-count":11,"title":["Primary versus postoperative stereotactic radiosurgery for acromegaly: a multicenter matched cohort study"],"prefix":"10.3171","volume":"132","author":[{"given":"Nasser","family":"Mohammed","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chieh","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Mart\u00ednez-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ruber Internacional Hospital, Madrid, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Mart\u00ednez-Moreno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ruber Internacional Hospital, Madrid, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikulas","family":"Kosak","sequence":"additional","affiliation":[{"name":"3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Cifarelli","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennadiy A.","family":"Katsevman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Dade","family":"Lunsford","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Lee Vance","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1210\/jc.2007-2104","article-title":"Divergence between growth hormone and insulin-like growth factor-I concentrations in the follow-up of acromegaly","volume":"93","author":"Alexopoulou O","year":"2008","unstructured":"Alexopoulou O, Bex M, Abs R, T\u2019Sjoen G, Velkeniers B, Maiter D: Divergence between growth hormone and insulin-like growth factor-I concentrations in the follow-up of acromegaly. J Clin Endocrinol Metab 93:1324\u20131330, 200810.1210\/jc.2007-210418230660"},{"key":"b2","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"3105","DOI":"10.1210\/jc.2002-021663","article-title":"Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study","volume":"88","author":"Attanasio R","year":"2003","unstructured":"Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L, Cozzi R, : Gamma-knife radiosurgery in acromegaly: a 4-year follow-up study. J Clin Endocrinol Metab 88:3105\u20133112, 20031284315010.1210\/jc.2002-021663"},{"key":"b3","series-title":"Multivariate Behav Res","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin PC","year":"2011","unstructured":"Austin PC: An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399\u2013424, 20112181816210.1080\/00273171.2011.568786"},{"key":"b4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"4483","DOI":"10.1210\/jc.2005-0311","article-title":"Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion","volume":"90","author":"Castinetti F","year":"2005","unstructured":"Castinetti F, Taieb D, Kuhn JM, Chanson P, Tamura M, Jaquet P, : Outcome of gamma knife radiosurgery in 82 patients with acromegaly: correlation with initial hypersecretion. J Clin Endocrinol Metab 90:4483\u20134488, 20051589995810.1210\/jc.2005-0311"},{"key":"b5","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1007\/BF03345306","article-title":"Cost-of-illness study in acromegalic patients in Italy","volume":"27","author":"Didoni G","year":"2004","unstructured":"Didoni G, Grottol S, Gasco V, Battistini M, Ferone D, Giusti M, : Cost-of-illness study in acromegalic patients in Italy. J Endocrinol Invest 27:1034\u20131039, 20041575473510.1007\/BF03345306"},{"key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1093\/neuros\/nyy178","article-title":"Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study","volume":"84","author":"Ding D","year":"2019","unstructured":"Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, : Stereotactic radiosurgery for acromegaly: an international multicenter retrospective cohort study. Neurosurgery 84:717\u2013725, 201910.1093\/neuros\/nyy17829757421"},{"key":"b7","series-title":"J Clin Endocrinol Metab","first-page":"3808","article-title":"Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly","volume":"83","author":"Freda PU","year":"1998","unstructured":"Freda PU, Post KD, Powell JS, Wardlaw SL: Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 83:3808\u20133816, 19989814451"},{"key":"b8","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1210\/jc.2003-031199","article-title":"Factors influencing mortality in acromegaly","volume":"89","author":"Holdaway IM","year":"2004","unstructured":"Holdaway IM, Rajasoorya RC, Gamble GD: Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89:667\u2013674, 20041476477910.1210\/jc.2003-031199"},{"key":"b9","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"3933","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson L","year":"2014","unstructured":"Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, : Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933\u20133951, 20142535680810.1210\/jc.2014-2700"},{"issue":"Suppl 1","key":"b10","series-title":"Stereotact Funct Neurosurg","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000056445","article-title":"Gamma Knife radiosurgery for functioning pituitary adenomas","volume":"72","author":"Kim SH","year":"1999","unstructured":"Kim SH, Huh R, Chang JW, Park YG, Chung SS: Gamma Knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg 72 (Suppl 1):101\u2013110, 199910.1159\/00005644510681697"},{"key":"b11","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1210\/jcem.85.3.6464","article-title":"Octreotide may act as a radioprotective agent in acromegaly","volume":"85","author":"Landolt AM","year":"2000","unstructured":"Landolt AM, Haller D, Lomax N, Scheib S, Schubiger O, Siegfried J, : Octreotide may act as a radioprotective agent in acromegaly. J Clin Endocrinol Metab 85:1287\u20131289, 200010.1210\/jcem.85.3.646410720077"},{"key":"b12","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1023\/B:NEON.0000041887.51906.b7","article-title":"Stereotactic radiosurgery for pituitary adenomas: a review of the literature","volume":"69","author":"Laws ER","year":"2004","unstructured":"Laws ER, Sheehan JP, Sheehan JM, Jagnathan J, Jane JA Jr, Oskouian R: Stereotactic radiosurgery for pituitary adenomas: a review of the literature. J Neurooncol 69:257\u2013272, 20041552709510.1023\/B:NEON.0000041887.51906.b7"},{"key":"b13","series-title":"Am J Epidemiol","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1093\/aje\/kwt212","article-title":"Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching","volume":"179","author":"Lunt M","year":"2014","unstructured":"Lunt M: Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching. Am J Epidemiol 179:226\u2013235, 20142411465510.1093\/aje\/kwt212"},{"key":"b14","series-title":"BMC Endocr Disord","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/1472-6823-9-20","article-title":"Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation","volume":"9","author":"Moore DJ","year":"2009","unstructured":"Moore DJ, Adi Y, Connock MJ, Bayliss S: Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation. BMC Endocr Disord 9:20, 20091981479710.1186\/1472-6823-9-20"},{"key":"b15","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"833","DOI":"10.3171\/jns.2007.106.5.833","article-title":"Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission","volume":"106","author":"Pollock BE","year":"2007","unstructured":"Pollock BE, Jacob JT, Brown PD, Nippoldt TB: Radiosurgery of growth hormone-producing pituitary adenomas: factors associated with biochemical remission. J Neurosurg 106:833\u2013838, 200710.3171\/jns.2007.106.5.83317542527"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"648","DOI":"10.3171\/2017.5.JNS163069","article-title":"Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study","volume":"129","author":"Pomeraniec IJ","year":"2018","unstructured":"Pomeraniec IJ, Kano H, Xu Z, Nguyen B, Siddiqui ZA, Silva D, : Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. J Neurosurg 129:648\u2013657, 201810.3171\/2017.5.JNS16306929076785"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3171\/2010.5.JNS091635","article-title":"Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes","volume":"114","author":"Sheehan JP","year":"2011","unstructured":"Sheehan JP, Pouratian N, Steiner L, Laws ER, Vance ML: Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. J Neurosurg 114:303\u2013309, 201110.3171\/2010.5.JNS09163520540596"},{"key":"b18","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3171\/jns.2006.104.1.157","article-title":"Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note","volume":"104","author":"Snell JW","year":"2006","unstructured":"Snell JW, Sheehan J, Stroila M, Steiner L: Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg 104:157\u2013162, 200610.3171\/jns.2006.104.1.157"},{"key":"b19","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1227\/00006123-199111000-00004","article-title":"Stereotactic radiosurgery with the cobalt-60 gamma unit in the treatment of growth hormone-producing pituitary tumors","volume":"29","author":"Thor\u00e9n M","year":"1991","unstructured":"Thor\u00e9n M, R\u00e4hn T, Guo WY, Werner S: Stereotactic radiosurgery with the cobalt-60 gamma unit in the treatment of growth hormone-producing pituitary tumors. Neurosurgery 29:663\u2013668, 199110.1227\/00006123-199111000-000041961394"},{"issue":"Suppl 3","key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3171\/jns.2000.93.supplement_3.0006","article-title":"Radiosurgery for growth hormone-producing pituitary adenomas","volume":"93","author":"Zhang N","year":"2000","unstructured":"Zhang N, Pan L, Wang EM, Dai JZ, Wang BJ, Cai PW: Radiosurgery for growth hormone-producing pituitary adenomas. J Neurosurg 93 (Suppl 3):6\u20139, 200010.3171\/jns.2000.93.supplement_3.000611143264"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/132\/5\/article-p1507.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/132\/5\/article-p1507.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/132\/5\/article-p1507.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T08:39:43Z","timestamp":1658738383000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/132\/5\/article-p1507.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":20,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2019.1.jns183398","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}