Objective: Various treatment modalities are used for acromegalic patients to normalise growth hormone and IGF-1 values to those matched with the normal population in order to normalise morbidity and mortality. A retrospective audit was undertaken to review the treatment outcomes of four therapy groups. 1. Surgery alone, 2. Surgery and radiotherapy, 3. Surgery, radiotherapy and adjunct therapy, 4. Surgery and adunct without radiotherapy.
Methodology: 66 patients were recruited with a mean follow up period of 11.6 years. All patients had undergone transspenoidal surgery as part of their clinical management. Outcome measures were classified as cure/control or with active disease measured by their last available IGF-1 value. Comparisons were made with the four groups concerning pre and post IGF-1 values, tumour size, tumour extension and presence of residual tumour in relation to outcome.
Results: Overall, 62% were cured or controlled. 20% were treated with surgery alone, 9% had surgery and radiotherapy, 45% had a combination of surgery and other therapies and 26% had surgery, adjunct therapy but no radiotherapy. Surgery alone resulted in cure for 77%. Disease control was evident in: Surgery and radiotherapy 50%, combined therapy including radiotherapy 60% and combined therapy without radiotherapy 59%. Of the 73% patients with residual disease, 37% continued to have active disease. 44% patients had tumour extension, 45% with active disease. Post-operative IGF-1 was significantly different to pre-operative levels. The most prevalent co-morbidity was hypopituritism followed closely by ACTH deficiency in 48% of patients. Data showed that there was a trend for ACTH deficiency in the two groups treated with radiotherapy but failed to reach significance.
Conclusion: This audit has shown as expected that there is a significant improvement in IGF-1 post treatment when compared to pre-treatment values in all groups. No relationship was found between residual disease, tumour size or tumour extension with outcome. However, the high prevalence of ACTH deficiency is a serious co-morbidity with little published data on this to date.