Somatostatin Therapy and Surgical Outcomes in Acromegaly: Insights From a Systematic Review and Meta-analysis
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Keywords
Acromegaly, post-operative outcome, surgical treatment, Preoperative Somatostatin therapy, cost-effectiveness
Abstract
The management of acromegaly, a chronic hormone disorder characterized by excessive growth hormone (GH) secretion, remains a subject of debate. This systematic review and meta-analysis aim to evaluate the impact of preoperative somatostatin analog (SA) treatment on surgical outcomes in acromegaly patients. A comprehensive search of medical databases was conducted following PRISMA guidelines, resulting in the inclusion of 15 studies published between 2013 and 2024, encompassing 4,387 patients with an average age of 46-47 years. The primary outcomes analyzed were surgical remission rates, postoperative GH levels, tumor volume reduction, and complication rates. Studies indicate that preoperative SA treatment significantly improves remission rates and reduces postoperative GH levels compared to surgery alone. For instance, one study reported a biochemical control rate of 59.5% in the SA group versus 46.5% in the non-SA group. Another study showed that preoperative SA treatment led to a higher rate of tumor volume reduction (62.5% vs. 53.7%). Additionally, patients treated with SAs experienced fewer surgical complications and higher rates of biochemical control. Despite the higher initial costs associated with SA treatment, long-term benefits such as reduced complications and enhanced surgical outcomes suggest it is a cost-effective approach. However, the analysis also highlights the need for further research on long-term outcomes, recurrence rates, patient quality of life, and the overall costeffectiveness of preoperative SA treatment. This study provides evidence supporting the integration of medical management into the preoperative care plan for acromegaly patients, emphasizing the potential benefits of SA treatment in improving surgical outcomes.
References
2. Bollerslev J, Heck A, Olarescu NC. Management of endocrine disease: individualised management of acromegaly. Eur J Endocrinol. 2019;181(2):R57-R71.
3. Paragliola RM, Salvatori R. Novel somatostatin receptor ligands therapies for acromegaly. Front Endocrinol (Lausanne). 2018;9:78.
4. Mercado M, Gonzalez B, Vargas G, Ramirez C, de los Monteros ALE, Sosa E, et al. Successful Mortality Reduction and Control of Comorbidities in Patients With Acromegaly Followed at a Highly Specialized Multidisciplinary Clinic. J Clin Endocrinol Metab. 2014;99(12):4438-46. https://doi.org/10.1210/jc.2014-2670
5. Margusino-Framiñán L, Pertega-Diaz S, Pena-Bello L, Sangiao-Alvarellos S, Outeiriño-Blanco E, Pita-Gutierrez F, et al. Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome. Eur J Intern Med. 2015;26(9):736-41. https://doi.org/10.1016/j.ejim.2015.07.019
6. Evran M, Sert M, Tetiker T. Clinical experiences and success rates of acromegaly treatment: the single center results of 62 patients. BMC Endocr Disord. 2014;14:1-8.
7. Carroll PV, Joshi MN. Acromegaly. In: Endocrinology and Diabetes. Springer; 2015.
8. Melmed S. Acromegaly. In: The Pituitary. 4th ed. Academic Press; 2017. p. 423-66.
9. Sarkar S, Chacko AG. Surgery for acromegaly. Neurol India. 2020;68(Suppl 1):S44-S51.
10. Corica G, Ceraudo M, Campana C, Nista F, Cocchiara F, Boschetti M, et al. Octreotide-resistant acromegaly: challenges and solutions. Ther Clin Risk Manag. 2020;16:379-91.
11. Sun L, Coy DH. Somatostatin and its analogs. Curr Drug Targets. 2016;17(5):529-37.
12. Nunes V, Correa J, Puga M, Silva E, Boguszewski C. Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system. Pituitary. 2015;18:500-8.
13. Araujo-Castro M, Pascual-Corrales E, Martínez-Vaello V, Baonza Saiz G, Quiñones de Silva J, Acitores Cancela A, et al. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J Endocrinol Invest. 2021;44:183-93.
14. Chin S, Ku C, Kim B, Kim S, Park K, Song K, et al. Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement. Endocrinol Metab (Seoul). 2019;34(1):53-62.
15. Ershadinia N, Tritos NA. Diagnosis and treatment of acromegaly: an update. Mayo Clin Proc. 2022;97(2):333-46.
16. Wilson TJ, McKean EL, Barkan AL, Chandler WF, Sullivan SE. Repeat endoscopic transsphenoidal surgery for acromegaly: remission and complications. Pituitary. 2013;16:459-64.
17. Abu Dabrh AM, Mohammed K, Asi N, Farah WH, Wang Z, Farah MH, et al. Surgical interventions and medical treatments in treatment-naïve patients with acromegaly: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(11):4003-14.
18. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.
19. Pita-Gutierrez F, Pertega-Diaz S, Pita-Fernandez S, Pena L, Lugo G, Sangiao-Alvarellos S, et al. Place of preoperative treatment of acromegaly with somatostatin analog on surgical outcome: a systematic review and meta-analysis. PLoS One. 2013;8(4):e61523. https://doi.org/10.1371/journal.pone.0061523
20. Duan L, Zhu H, Xing B, Gu F. Prolonged preoperative treatment of acromegaly with Somatostatin analogs may improve surgical outcome in patients with invasive pituitary macroadenoma (Knosp grades 1–3): a retrospective cohort study conducted at a single center. BMC Endocr Disord. 2017;17:1-9.
21. Albarel F, Castinetti F, Morange I, Guibert N, Graillon T, Dufour H, et al. Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly. Pituitary. 2018;21(6):615-23.
22. Albarel F, Cuny T, Graillon T, Dufour H, Brue T, Castinetti F. Preoperative medical treatment for patients with acromegaly: yes or no? J Endocr Soc. 2022;6(9):bvac114.
23. Ku CR, Melnikov V, Zhang Z, Lee EJ. Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality? Endocrinol Metab (Seoul). 2020;35(2):206-16. https://doi.org/10.3803/EnM.2020.35.2.206
24. Colao A, Auriemma RS, Pivonello R. The effects of somatostatin analogue therapy on pituitary tumor volume in patients with acromegaly. Pituitary. 2016;19(2):210-21. https://doi.org/10.1007/s11102-015-0677-y
25. Jacob JJ, Bevan JS. Should all patients with acromegaly receive somatostatin analogue therapy before surgery and, if so, for how long? Clin Endocrinol (Oxf). 2014;81(6):812-7. https://doi.org/10.1111/cen.12553
26. Araujo-Castro M, Pian H, Ruz-Caracuel I, Acitores Cancela A, Pascual-Corrales E, Rodríguez Berrocal V. Presurgical somatostatin receptor ligand treatment does not affect tumor consistency in GH-secreting pituitary macroadenomas. Endocr Connect. 2021;10(1):102-9. https://doi.org/10.1530/ec-20-0414
27. Rotermund R, Mader MM, Burkhardt T, Matschke J, Aberle J, Krajewski K, et al. Real-life analysis of 280 patients with surgically treated acromegaly: a single-center experience from 2008 to 2015. Neurosurg Focus. 2020;48(6):E9. https://doi.org/10.3171/2020.3.Focus2061
28. Bolanowski M, Zgliczyński W, Sowiński J, Bałdys-Waligórska A, Bednarek-Tupikowska G, Witek P, et al. Therapeutic effect of presurgical treatment with long-acting octreotide (Sandostatin® LAR®) in patients with acromegaly. Endokrynol Pol. 2020;71(4):285-91.
29. Giustina A, Barkhoudarian G, Beckers A, Ben-Shlomo A, Biermasz N, Biller B, et al. Multidisciplinary management of acromegaly: A consensus. Rev Endocr Metab Disord. 2020;21(4):667-78. https://doi.org/10.1007/s11154-020-09588-z
30. Papaioannou C, Druce M. Preoperative medical treatments and surgical approaches for acromegaly: A systematic review. Clin Endocrinol (Oxf). 2023;98(1):14-31. https://doi.org/10.1111/cen.14790
31. Cheok SK, Carmichael JD, Zada G. Management of growth hormone–secreting pituitary adenomas causing acromegaly: a practical review of surgical and multimodal management strategies for neurosurgeons. J Neurosurg. 2023;140(5):1285-94.
32. Bonert V, Mirocha J, Carmichael J, Yuen KC, Araki T, Melmed S. Cost-effectiveness and efficacy of a novel combination regimen in acromegaly: a prospective, randomized trial. J Clin Endocrinol Metab. 2020;105(9):e3236-e3245.
33. Elbaum M, Mizera Ł, Bolanowski M. The real costs of acromegaly: analysis of different therapies. Endokrynol Pol. 2019;70(1).
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