This protocol applies to patients with acromegaly whose tumor is not curable by surgery — specifically those with extensive cavernous sinus invasion without optic chiasm compression, or those who are poor surgical candidates. In this population, primary medical management has already been pursued.
The preceding treatment line consisted of combination medical therapy: a somatostatin receptor ligand (SRL) with the addition of pegvisomant or cabergoline. That regimen's primary goal — normalization of serum IGF-1 — was not achieved. The current protocol represents the next clinical step following that failure.
For residual tumor mass in this setting, the strategy shifts to radiation therapy. Among the available radiotherapy modalities, a specific technique is preferred under the appropriate anatomical conditions — the full selection criteria, sequencing, and monitoring plan are contained in the complete protocol.
Success is defined as normalized serum IGF-1 and GH < 1 µg/L, evaluated on annual reassessment following medication withdrawal.
DOI: 10.1210/jc.2014-2700
We suggest use of an SRL as primary therapy in a patient who cannot be cured by surgery, has extensive cavernous sinus invasion, does not have chiasmal compression, or is a poor surgical candidate.
We suggest use of radiation therapy in the setting of residual tumor mass following surgery, and if medical therapy is unavailable, unsuccessful, or not tolerated.
We suggest use of stereotactic radiotherapy (SRT) over conventional radiation therapy in patients with acromegaly, unless the technique is not available, there is significant residual tumor burden, or the tumor is too close to the optic chiasm resulting in an exposure of more than 8 Gy.
To monitor the efficacy of radiation therapy, we recommend annual GH/IGF-1 reassessment following medication withdrawal.
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