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Stratégies thérapeutiques dans les adénomes somatotropes avec extension extrasellaire. Place du traitement médical. Etude consensus du Répetoire français de l'Acromégalie [Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry]
Consensus Development Conference English Abstract Journal Article Review --- Old month value: Dec
From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05). RESULTS: 46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.
Acromegaly/etiology, Acromegaly/surgery, Adenoma/drug therapy, Adenoma/pathology, Adenoma/</QualifierName> <QualifierName MajorTopicYN="Y">, Adult, Aged, Cavernous Sinus/pathology, Combined Modality Therapy, Female, Human Growth Hormone/secretion, Humans, Hypophysectomy/methods, Insulin-Like Growth Factor I/analysis, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Invasiveness, Octreotide/therapeutic use, Pituitary Neoplasms/drug therapy, Pituitary Neoplasms/pathology, Pituitary Neoplasms/</QualifierName> <QualifierName MajorTopicYN="Y">, Radiotherapy, Adjuvant, Registries, Somatostatin/analogs &, derivatives, Somatostatin/therapeutic use, Treatment Outcome
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