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Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing Disease: Results from a Multicenter, International Cohort Study

MJ. Shepard, GU. Mehta, Z. Xu, H. Kano, N. Sisterson, YH. Su, M. Krsek, AM. Nabeel, A. El-Shehaby, KA. Kareem, N. Martinez-Moreno, D. Mathieu, BJ. McShane, K. Blas, D. Kondziolka, I. Grills, JY. Lee, R. Martinez-Alvarez, WA. Reda, R. Liscak, CC....

. 2018 ; 116 (-) : e670-e679. [pub] 20180518

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc19000718

BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS. RESULTS: A total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm3, and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS and those who underwent discreet adenoma-targeted SRS. CONCLUSIONS: Whole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS.

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$a BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS. RESULTS: A total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm3, and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS and those who underwent discreet adenoma-targeted SRS. CONCLUSIONS: Whole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS.
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$a Mehta, Gautam U $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
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$a Xu, Zhiyuan $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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$a Kano, Hideyuki $u Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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$a Sisterson, Nathaniel $u Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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$a Su, Yan-Hua $u Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
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$a Krsek, Michal $u Second Department of Medicine, Third Faculty of Medicine of the Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
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$a Nabeel, Ahmed M $u Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt.
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$a El-Shehaby, Amr $u Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt.
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$a Kareem, Khaled A $u Clinical Oncology Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt.
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$a Martinez-Moreno, Nuria $u Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain.
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$a Mathieu, David $u Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.
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$a McShane, Brendan J $u Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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$a Kondziolka, Douglas $u Department of Neurosurgery, New York University Lagone Medical Center, New York, New York, USA.
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$a Grills, Inga $u Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA.
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$a Lee, John Y $u Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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$a Martinez-Alvarez, Roberto $u Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain.
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$a Reda, Wael A $u Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt.
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$a Liscak, Roman $u Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
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$a Sheehan, Jason P $u Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA. Electronic address: jsheehan@virginia.edu.
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