{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:30:58Z","timestamp":1772109058094,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T00:00:00Z","timestamp":1612051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng\/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng\/mL and 1.14, as well as 196 ng\/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.<\/jats:p>","DOI":"10.3390\/cancers13030537","type":"journal-article","created":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T21:31:56Z","timestamp":1612128716000},"page":"537","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas\u2014A Multicenter Experience"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6177-1755","authenticated-orcid":false,"given":"Felix","family":"Ehret","sequence":"first","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany"},{"name":"European Cyberknife Center, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Kufeld","sequence":"additional","affiliation":[{"name":"European Cyberknife Center, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"F\u00fcrweger","sequence":"additional","affiliation":[{"name":"European Cyberknife Center, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred","family":"Haidenberger","sequence":"additional","affiliation":[{"name":"European Cyberknife Center, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1040-4888","authenticated-orcid":false,"given":"Paul","family":"Windisch","sequence":"additional","affiliation":[{"name":"European Cyberknife Center, 81377 Munich, Germany"},{"name":"Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Fichte","sequence":"additional","affiliation":[{"name":"CyberKnife Center Mitteldeutschland, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Lehrke","sequence":"additional","affiliation":[{"name":"German CyberKnife Center, 59494 Soest, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Senger","sequence":"additional","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Charit\u00e9 CyberKnife Center, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kaul","sequence":"additional","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, 13353 Berlin, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Rue\u00df","sequence":"additional","affiliation":[{"name":"Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Ruge","sequence":"additional","affiliation":[{"name":"Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Schichor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg-Christian","family":"Tonn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1975-3294","authenticated-orcid":false,"given":"G\u00fcnter","family":"Stalla","sequence":"additional","affiliation":[{"name":"Medicover Neuroendocrinology, 81667 Munich, Germany"},{"name":"Department of Medicine IV, Ludwig-Maximilians-University Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Muacevic","sequence":"additional","affiliation":[{"name":"European Cyberknife Center, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s11102-016-0754-x","article-title":"Epidemiology of acromegaly: Review of population studies","volume":"20","author":"Lavrentaki","year":"2017","journal-title":"Pituitary"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1001\/jama.2016.19699","article-title":"Diagnosis and Treatment of Pituitary Adenomas: A Review","volume":"317","author":"Molitch","year":"2017","journal-title":"Jama"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1530\/eje.1.01863","article-title":"The outcome of surgery in 668 patients with acromegaly using 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