Journal Article

Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study

Martinez-Alvarez, Roberto, Reda, Wael A, Kondziolka, Douglas, Lunsford, L Dade, Su, Yan-Hua, Liscak, Roman, Ding, Dale, Martinez-Moreno, Nuria, Patibandla, Mohana Rao, Grills, Inga, Lee, John Y, Lee, Cheng-Chia, Mathieu, David, McShane, Brendan, Sheehan, Jason P, Kareem, Khaled A, Blas, Kevin, Krsek, Michal, El-Shehaby, Amr, Sisterson, Nathaniel, Kano, Hideyuki, Nabeel, Ahmed M, Mehta, Gautam U, Vance, Mary Lee

2017

Overview

ContextCushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge.ObjectiveTo better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management.DesignInternational, multicenter, retrospective cohort analysis.SettingTen medical centers participating in the International Gamma Knife Research Foundation.PatientsPatients with CD with >6 months endocrine follow-up.InterventionSRS using Gamma Knife radiosurgery.Main Outcome MeasuresThe primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded.ResultsIn total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation.ConclusionsSRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS.We studied the outcomes of stereotactic radiosurgery for Cushing disease in 278 patients and found that this treatment can result in durable endocrine remission in appropriately selected patients.

• Publisher: Endocrine Society,Copyright Oxford University Press,Oxford University Press
• Subject: ACTH-Secreting Pituitary Adenoma - secretion / ACTH-Secreting Pituitary Adenoma - surgery / Adenoma - secretion / Adenoma - surgery / Adolescent / Adrenocorticotropic hormone / Adult / Aged / Aged, 80 and over / Brain cancer / Brain tumors / Child / Cortisol / Cushing syndrome / Cushing's disease / Female / Follow-Up Studies / Hormones / Humans / Hydrocortisone / Hypopituitarism / Male / Middle Aged / Nervous system diseases / Neuropathy / Patients / Pituitary / Pituitary ACTH Hypersecretion - surgery / Pituitary gland / Radiation / Radiation measurement / Radiosurgery / Radiosurgery - methods / Remission / Retrospective Studies / Skull / Surgery / Treatment Outcome / Tumors / Young Adult