Gautam U Mehta1, Dale Ding1, Mohana Rao Patibandla1, Hideyuki Kano2, Nathaniel Sisterson2, Yan-Hua Su3, Michal Krsek4, Ahmed M Nabeel5, Amr El-Shehaby6, Khaled A Kareem7, Nuria Martinez-Moreno8, David Mathieu9, Brendan McShane10, Kevin Blas11, Douglas Kondziolka12, Inga Grills11, John Y Lee10, Roberto Martinez-Alvarez8, Wael A Reda6, Roman Liscak13, Cheng-Chia Lee3, L Dade Lunsford2, Mary Lee Vance1,14, Jason P Sheehan1. 1. Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia 22908. 2. Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213. 3. Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan, Republic of China. 4. Second Department of Medicine, Third Faculty of Medicine of the Charles University, Faculty Hospital Kralovske Vinohrady, 11636 Prague, Czech Republic. 5. Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt 11566. 6. Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt 11566. 7. Clinical Oncology Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt 11566. 8. Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, 28034 Madrid, Spain. 9. Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec J1H 5N4, Canada. 10. Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104. 11. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan 48073. 12. Department of Neurosurgery, New York University Lagone, Medical Center, New York, New York 10016. 13. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, 11636 Prague, Czech Republic. 14. Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908.
Abstract
Context: Cushing disease (CD) due to adrenocorticotropic hormone-secreting pituitary tumors can be a management challenge. Objective: To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management. Design: International, multicenter, retrospective cohort analysis. Setting: Ten medical centers participating in the International Gamma Knife Research Foundation. Patients: Patients with CD with >6 months endocrine follow-up. Intervention: SRS using Gamma Knife radiosurgery. Main Outcome Measures: The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded. Results: In 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. Conclusions: SRS 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.
Context:Cushing disease (CD) due to adrenocorticotropic hormone-secreting pituitary tumors can be a management challenge. Objective: To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management. Design: International, multicenter, retrospective cohort analysis. Setting: Ten medical centers participating in the International Gamma Knife Research Foundation. Patients: Patients with CD with >6 months endocrine follow-up. Intervention: SRS using Gamma Knife radiosurgery. Main Outcome Measures: The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded. Results: In 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. Conclusions: SRS 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.
Authors: Gautam U Mehta; Dale Ding; Amitabh Gupta; Hideyuki Kano; Nathaniel D Sisterson; Nuria Martinez-Moreno; Michal Kršek; Huai-Che Yang; Cheng-Chia Lee; Roman Liščák; Roberto Martinez-Alvarez; L Dade Lunsford; Mary Lee Vance; Jason P Sheehan Journal: J Neurooncol Date: 2018-03-03 Impact factor: 4.130
Authors: Maria Fleseriu; Richard Auchus; Irina Bancos; Anat Ben-Shlomo; Jerome Bertherat; Nienke R Biermasz; Cesar L Boguszewski; Marcello D Bronstein; Michael Buchfelder; John D Carmichael; Felipe F Casanueva; Frederic Castinetti; Philippe Chanson; James Findling; Mônica Gadelha; Eliza B Geer; Andrea Giustina; Ashley Grossman; Mark Gurnell; Ken Ho; Adriana G Ioachimescu; Ursula B Kaiser; Niki Karavitaki; Laurence Katznelson; Daniel F Kelly; André Lacroix; Ann McCormack; Shlomo Melmed; Mark Molitch; Pietro Mortini; John Newell-Price; Lynnette Nieman; Alberto M Pereira; Stephan Petersenn; Rosario Pivonello; Hershel Raff; Martin Reincke; Roberto Salvatori; Carla Scaroni; Ilan Shimon; Constantine A Stratakis; Brooke Swearingen; Antoine Tabarin; Yutaka Takahashi; Marily Theodoropoulou; Stylianos Tsagarakis; Elena Valassi; Elena V Varlamov; Greisa Vila; John Wass; Susan M Webb; Maria C Zatelli; Beverly M K Biller Journal: Lancet Diabetes Endocrinol Date: 2021-10-20 Impact factor: 32.069
Authors: James R Janopaul-Naylor; Manali Rupji; Jim Zhong; Bree R Eaton; Naba Ali; Adriana G Ioachimescu; Nelson M Oyesiku; Hui-Kuo G Shu Journal: World Neurosurg Date: 2021-12-28 Impact factor: 2.210
Authors: Leah T Braun; German Rubinstein; Stephanie Zopp; Frederick Vogel; Christine Schmid-Tannwald; Montserrat Pazos Escudero; Jürgen Honegger; Roland Ladurner; Martin Reincke Journal: Endocrine Date: 2020-08-02 Impact factor: 3.633