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Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study
GU. Mehta, D. Ding, MR. Patibandla, H. Kano, N. Sisterson, YH. Su, M. Krsek, AM. Nabeel, A. El-Shehaby, KA. Kareem, N. Martinez-Moreno, D. Mathieu, B. McShane, K. Blas, D. Kondziolka, I. Grills, JY. Lee, R. Martinez-Alvarez, WA. Reda, R. Liscak,...
Language English Country United States
Document type Journal Article, Multicenter Study
NLK
Free Medical Journals
from 1997 to 1 year ago
ProQuest Central
from 2017-01-01 to 2020-12-31
Health & Medicine (ProQuest)
from 2017-01-01 to 2020-12-31
PubMed
28938462
DOI
10.1210/jc.2017-01385
Knihovny.cz E-resources
- MeSH
- ACTH-Secreting Pituitary Adenoma secretion surgery MeSH
- Adenoma secretion surgery MeSH
- Child MeSH
- Adult MeSH
- Pituitary ACTH Hypersecretion surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Radiosurgery * methods MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
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.
Department of Neurologic Surgery University of Virginia Health System Charlottesville Virginia 22908
Department of Neurosurgery New York University Lagone Medical Center New York New York 10016
Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania 19104
Department of Radiation Oncology Beaumont Health System Royal Oak Michigan 48073
Neurosurgery Department Gamma Knife Center Cairo Nasser Institute Benha University Benha Egypt 11566
References provided by Crossref.org
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- $a Mehta, Gautam U $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia 22908.
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- $a Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study / $c GU. Mehta, D. Ding, MR. Patibandla, H. Kano, N. Sisterson, YH. Su, M. Krsek, AM. Nabeel, A. El-Shehaby, KA. Kareem, N. Martinez-Moreno, D. Mathieu, B. McShane, K. Blas, D. Kondziolka, I. Grills, JY. Lee, R. Martinez-Alvarez, WA. Reda, R. Liscak, CC. Lee, LD. Lunsford, ML. Vance, JP. Sheehan,
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- $a 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.
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