Does radiosurgery have a role in the treatment of acromegaly?

Surgical treatment of acromegaly aims to normalize the levels of growth hormone and insulin-like growth factor I (IGF-I) and to control tumor growth; however, not all patients achieve remission. Treatment of residual tumor or recurrent disease, therefore, requires additional modalities, such as somatostatin analogs or radiosurgery. Losa et al. have evaluated the efficacy and safety of radiosurgery in a cohort of 83 patients with acromegaly who had previously undergone surgical debulking. The authors reported a 5-year biochemical remission rate of 52.6% after treatment. Remission was found to correlate with the baseline growth hormone and IGF-I levels, but not with tumor volume. In this Practice Point commentary, we place the findings of Losa et al. into clinical context, discuss the possible limitations of their approach, and comment on the relevance of radiosurgery to the treatment of acromegaly.