142   Stereotactic Radiosurgery for Medically and Surgically Refractory XXXX : Long-term Rates of Remission and @entity4614 .

@entity1 @entity227 @entity5 @entity442 @entity2895 @entity2124 @entity2012 @entity4614 @entity7961
INTRODUCTION: @entity2012 is a challenging clinical entity. Despite improvements in microsurgery and medical therapy, @entity2012 persists or recurs in many @entity1 . We evaluate the long-term results of stereotactic radiosurgery (SRS) for acromegalic @entity1 . METHODS: This was a retrospective study of @entity1 treated with SRS at the University of Virginia; the data were collected from 1989 to 2013. A total of 136 @entity1 underwent SRS for @entity2012 . Diagnosis of @entity2012 was based on the combination of clinical features and biochemical assessment including to serum @entity2124 ( @entity2124 ) level, and age- and sex-matched serum @entity442 ( @entity442 ) level. All @entity1 underwent a complete endocrine evaluation, neuroimaging study, and ophthalmic examinations before SRS. @entity1 who had an OGTT @entity2124 of <1.0 ng/mL or normal @entity442 were considered in remission. @entity4614 was defined as a decrease in one or more hormones below normal. RESULTS: With a median follow-up of 61.5 months, 65.4% of the @entity1 achieved remission. The mean time to remission was 27.5 months. The actuarial remission rates at 2, 4, 6, and 8 years postradiosurgery were 31.7%, 64.5%, 73.4%, and 82.6%, respectively. Significant prognostic factors (P < .05) for remission included a higher margin radiation dose, higher maximum dose, and lower initial @entity442 level. New @entity7961 occurred in 43 @entity1 (31.6%); 2 @entity1 (1.5%) developed @entity7961 . Risk factors for new @entity7961 were a margin dose >25 Gy and @entity5 volume >2.5 mL. Other complications included an adverse radiation effect in 1 @entity1 , @entity227 in 4, and new @entity2895 in 1. CONCLUSION: SRS affords endocrine remission in the majority of acromegalic @entity1 . Delivering a higher radiation dose portends a greater chance of remission. The most common complication after SRS was @entity4614 , but this occurs in a minority of @entity1 .
