Stereotactic radiosurgery XVI: a treatment for previously irradiated XXXX .

@entity1 @entity5 @entity442 @entity2012 @entity977 @entity652
We report the use of stereotactic radiosurgery delivered through an adapted linear accelerator [stereotactic multiple arc radiation therapy (SMART)] for @entity977 not cured by conventional therapy. All 21 @entity1 had undergone conventional radiotherapy (45-50 Gy); 18 had also undergone prior surgery. This cohort comprised 13 @entity1 with somatotrope @entity652 , four with @entity652 , one with a lactotrope @entity652 , and three with nonfunctioning @entity977 (median follow-up: 33 months, range: 3-72 months). SMART has proven effective, safe, and rapidly acting. We observed an accelerated reduction in GH and @entity442 levels in @entity2012 , with normalization of GH and @entity442 levels in 58%. Mean GH fell from 21.1 mU/liter to 7.9 mU/liter (7 ng/ml to 2.6 ng/ml, P < 0.01, median 25 months) faster than our predicted fall to 50% at 2 yr with conventional radiotherapy. Mean @entity442 fell from 624 ng/ml to 384 ng/ml (P < 0.001). @entity5 growth was controlled in two of three nonfunctioning @entity977 , and three of four @entity652 . There were no adverse effects from SMART. Notably there have been no visual sequelae or further loss of anterior pituitary function in this heavily pretreated group. Our data indicate that SMART is an effective complementary therapy for @entity977 that have displayed a suboptimal response to conventional therapy including external irradiation.
