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Upfront Gamma Knife radiosurgery for Cushing's disease and acromegaly: a multicenter, international study

A. Gupta, Z. Xu, H. Kano, N. Sisterson, YH. Su, M. Krsek, AM. Nabeel, A. El-Shehaby, KA. Karim, N. Martínez-Moreno, D. Mathieu, BJ. McShane, R. Martínez-Álvarez, WA. Reda, R. Liscak, CC. Lee, LD. Lunsford, JP. Sheehan,

. 2018 ; 131 (2) : 532-538. [pub] 20180817

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/bmc19045296

OBJECTIVE: Gamma Knife radiosurgery (GKS) is typically used after failed resection in patients with Cushing's disease (CD) and acromegaly. Little is known about the upfront role of GKS for patients with CD and acromegaly. In this study, the authors examine the outcome of upfront GKS for patients with these functioning adenomas. METHODS: An international group of 7 Gamma Knife centers sent pooled data from 46 patients (21 with CD and 25 with acromegaly) undergoing upfront GKS to the coordinating center of the study for analysis. Diagnosis was established on the basis of clinical, endocrine, and radiological studies. All patients were treated on a common radiosurgical platform and longitudinally followed for tumor control, endocrine remission, and hypopituitarism. Patients received a tumor median margin dose of 25 Gy (range 12-40.0 Gy) at a median isodose of 50%. RESULTS: The median endocrine follow-up was 69.5 months (range 9-246 months). Endocrine remission was achieved in 51% of the entire cohort, with 28% remission in acromegaly and 81% remission for those with CD at the 5-year interval. Patients with CD achieved remission earlier as compared to those with acromegaly (p = 0.0005). In patients post-GKS, the pituitary adenoma remained stable (39%) or reduced (61%) in size. Hypopituitarism occurred in 9 patients (19.6%), and 1 (2.2%) developed third cranial nerve (CN III) palsy. Eight patients needed further intervention, including repeat GKS in 6 and transsphenoidal surgery in 2. CONCLUSIONS: Upfront GKS resulted in good tumor control as well as a low rate of adverse radiation effects in the whole group. Patients with CD achieved a faster and far better remission rate after upfront GKS in comparison to patients with acromegaly. GKS can be considered as an upfront treatment in carefully selected patients with CD who are unwilling or unable to undergo resection, but it has a more limited role in acromegaly.

Citace poskytuje Crossref.org

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$a Gupta, Amitabh $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
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$a Xu, Zhiyuan $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
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$a Kano, Hideyuki $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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$a Sisterson, Nathaniel $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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$a Su, Yan-Hua $u 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
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$a Krsek, Michal $u 4Second Department of Medicine, Third Faculty of Medicine of the Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
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$a Nabeel, Ahmed M $u 5Gamma Knife Center Cairo-Nasser Institute, Neurosurgery Department, Benha University, Benha, Egypt.
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$a El-Shehaby, Amr $u 6Gamma Knife Center Cairo-Nasser Institute, Neurosurgery Department, Ain Shams University, Cairo, Egypt.
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$a Karim, Khaled A $u 7Gamma Knife Center Cairo-Nasser Institute, Clinical Oncology Department, Ain Shams University, Cairo, Egypt.
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$a Martínez-Moreno, Nuria $u 8Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain.
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$a Mathieu, David $u 9Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada; and.
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$a McShane, Brendan J $u 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
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$a Martínez-Álvarez, Roberto $u 8Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain.
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$a Reda, Wael A $u 6Gamma Knife Center Cairo-Nasser Institute, Neurosurgery Department, Ain Shams University, Cairo, Egypt.
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$a Liscak, Roman $u 10Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
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$a Lee, Cheng-Chia $u 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
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$a Lunsford, L Dade $u 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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