OBJECTIVE: The optimal time to perform stereotactic radiosurgery after incomplete resection of adrenocorticotropic hormone (ACTH)-producing pituitary adenoma in patients with Cushing's disease (CD) remains unclear. In patients with persistent CD after resection of ACTH-producing pituitary adenoma, the authors evaluated the association of the interval between resection and Gamma Knife radiosurgery (GKRS) with outcomes. METHODS: Pooled data from 10 institutions participating in the International Radiosurgery Research Foundation were used in this study. RESULTS: Data from 255 patients with a mean follow-up of 65.59 ± 49.01 months (mean ± SD) were analyzed. Seventy-seven patients (30%) underwent GKRS within 3 months; 46 (18%) from 4 to 6 months; 34 (13%) from 7 to 12 months; and 98 (38%) at > 12 months after the resection. Actuarial endocrine remission rates were higher in patients who underwent GKRS ≤ 3 months than when treatment was > 3 months after the resection (78% and 65%, respectively; p = 0.017). Endocrine remission rates were lower in patients who underwent GKRS at > 12 months versus ≤ 12 months after the resection (57% vs 76%, respectively; p = 0.006). In multivariate Cox regression analyses adjusted for clinical and treatment characteristics, early GKRS was associated with increased probability of endocrine remission (hazard ratio [HR] 1.518, 95% CI 1.039-2.218; p = 0.031), whereas late GKRS (HR 0.641, 95% CI 0.448-0.919; p = 0.015) was associated with reduced probability of endocrine remission. The incidence of some degree of new pituitary deficiency (p = 0.922), new visual deficits (p = 0.740), and other cranial nerve deficits (p = 0.610) was not significantly related to time from resection to GKRS. CONCLUSIONS: Early GKRS is associated with an improved endocrine remission rate, whereas later GKRS is associated with a lower rate of endocrine remission after pituitary adenoma resection. Early GKRS should be considered for patients with CD after incomplete pituitary adenoma resection.

3rd Department of Internal Medicine 1st Faculty of Medicine of the Charles University and General Teaching Hospital Prague Czech Republic

Clinical Oncology Department Gamma Knife Center Cairo Nasser Institute Ain Shams University Cairo Egypt

Department of Functional Neurosurgery and Radiosurgery Ruber International Hospital Madrid Spain

Department of Medicine University of Virginia Health System Charlottesville Virginia

Department of Neurologic Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania

Department of Neurologic Surgery University of Virginia Health System Charlottesville Virginia

Department of Neurosurgery Neurologic Institute Taipei Veterans General Hospital Taipei Taiwan Republic of China

Department of Neurosurgery New York University Langone Medical Center New York New York

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania

Department of Radiation Oncology Beaumont Health System Royal Oak Michigan

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic; and

Division of Neurosurgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Quebec Canada

Neurosurgery Department Gamma Knife Center Cairo Nasser Institute Ain Shams University Cairo Egypt

Neurosurgery Department Gamma Knife Center Cairo Nasser Institute Benha University Benha Egypt

J Neurosurg. 2020 Jul 31;134(3):1012-1014. doi: 10.3171/2020.6.JNS202134. PubMed

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