Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial

• Published in: European journal of endocrinology Vol. 162; no. 4; pp. 661 - 666
• Main Authors: Mao, Zhi-gang, Zhu, Yong-hong, Tang, Hai-liang, Wang, Dao-yuan, Zhou, Jing, He, Dong-sheng, Lan, Hai, Luo, Bai-ning, Wang, Hai-jun
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01.04.2010; European Society of Endocrinology
• Subjects: Acromegaly - blood; Acromegaly - drug therapy; Acromegaly - surgery; Adenoma - blood; Adenoma - drug therapy; Adenoma - surgery; Adult; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Chi-Square Distribution; Clinical Study; Combined Modality Therapy; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Human Growth Hormone - blood; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-Like Growth Factor I - metabolism; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Peptides, Cyclic - administration & dosage; Pituitary Neoplasms - blood; Pituitary Neoplasms - drug therapy; Pituitary Neoplasms - surgery; Preoperative Care; Prospective Studies; Somatostatin - administration & dosage; Somatostatin - analogs & derivatives; Vertebrates: endocrinology; Endocrinopathy; Short term; Human; Postoperative; Peptides; Cure; Rate; Diseases of the osteoarticular system; Acromegaly; Patient; Increase; Adenoma; Prospective; Octapeptide; Randomization; Treatment; Surgery; Lanreotide; Pituitary diseases; Clinical trial; Benign neoplasm; Preoperative; Endocrinology
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/EJE-09-0908

ObjectiveTo investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas.DesignA prospective, randomised study.MethodsAfter a baseline evaluation, patients were randomly assigned to 4-month preoperative treatment with lanreotide (starting with 30 mg/2 weeks i.m. and increasing to 30 mg/week i.m. at week 8 if mean GH >2.5 μg/l on GH day curves; pretreatment group, Group 1) or to transsphenoidal surgery (direct surgery group, Group 2). Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal.ResultsA pool of 108 patients was randomly divided into two groups. Five patients in each group were lost to follow-up during the study period, so 49 patients in each group were analysed. At baseline, no difference was observed between the two groups. Cure was established in 24 of 49 (49.0%, 95% confidence interval (CI), 35.0–63.0%) pretreated patients (Group 1) versus 9 of 49 (18.4%, 95% CI, 7.6–29.2%) direct surgery patients (Group 2; P=0.001). Surgical morbidity was recorded in 12 patients (12.2%) and was similar in Group 1 and 2 patients (14.3 and 10.2% respectively; P=0.538). The postoperative hospital stay was similar between groups: being 4.5±1.6 days in Group 1 vs 4.8±1.9 days in Group 2 (P=0.328).ConclusionsPretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas. Pretreatment does not affect surgical complications or duration of hospital stay (ClinicalTrials.gov number, NCT00993356).