Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Castinetti, Frédéric; Nagai, Mariko; Dufour, Henry; Jm, Kuhn; Morange, Isabelle; Jaquet, P; Conte-Devolx, B.; Régis, Jean; Brue, Thierry

doi:10.1530/eje.1.02323

Cited by 161 publications

(128 citation statements)

References 29 publications

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“…The reported tumour control in SRS studies in patients with Cushing's disease was 94% at a corrected median follow-up of 45 months (table 2) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). This compares to the 5-year tumour control rate (progression free survival) in all pituitary adenomas of 91.5% (39)(40)(41)(42), which is worse than reported following fractionated RT even though the tumours treated are smaller.…”

Section: Radiosurgerymentioning

confidence: 77%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

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Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease. RESUMORadioterapia e Radiocirurgia para a Doença de Cushing. Pacientes com doença de Cushing residual ou recorrente recebem radioterapia externa em feixe (RT) com o objetivo de alcançar um controle tumoral prolongado e a normalização dos níveis hormonais elevados. O tratamento é realizado tanto com RT convencional, usando técnicas conformacionais, ou com RT estereotáxica, que é usada tanto como tratamento fracionado (RTF) ou como radiocirurgia em procedimento único (RCU). Descreveremos os aspectos técnicos do tratamento e mostraremos uma revisão sistemática da literatura sobre a eficácia e toxicidade da RT convencional, da RTF e da RCU. Não existem estudos comparando diretamente as diferentes técnicas de radiação, e os resultados reportados são inevitavelmente os de pacientes selecionados pelos investigadores com interesse no tratamento testado. De qualquer maneira, a revisão dos dados publicados sugere que há melhores taxas de controle hormonal e tumoral após RTF em comparação com RCU. O hipopituitarismo representa a complicação tardia mais comumente relatada da RT, vista após todos os tipos de tratamento. Embora a incidência de outros efeitos tardios seja baixa, o risco de a radiação comprometer estrutura...

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Section: Radiosurgerymentioning

confidence: 77%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

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“…A literature review was conducted and eight studies identified as the most appropriate clinical studies for inclusion in the total budget impact model 37,38,[40][41][42][43][44][45] . Fourteen unique AEs were identified, of which hypopituitarism was associated with TSS, RS, and RT.…”

Section: Surgical Complications and Adverse Eventsmentioning

confidence: 99%

Budget impact of pasireotide for the treatment of Cushing’s disease, a rare endocrine disorder associated with considerable comorbidities

Truong

Nellesen

Ludlam

et al. 2014

Journal of Medical Economics

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Vol. 17, No. 4, 2014, 288-295 Cushing's disease (CD) is a rare condition with a prevalence of roughly 39 cases per million in the general population. Healthcare costs are substantial for CD patients with either untreated or inadequately controlled disease. This study assesses the 3-year budget impact of pasireotide on a US managed care health plan following pasireotide (Signifor*) availability. Methods:Two scenarios were evaluated to understand the differences in costs associated with the introduction of pasireotide. The first scenario evaluates the budget impact of pasireotide from the perspective of an entire health plan (total budget impact) and the second from the perspective of the pharmacy budget (pharmacy budget impact). Both scenarios evaluate the annual incremental budget impact with and without pasireotide. Scenario 1 includes costs for medical procedures, drug therapies, monitoring, surgical complications, comorbidities for patients with controlled or uncontrolled CD, and adverse events. Procedures include transsphenoidal surgery, bilateral adrenalectomy, radiotherapy and radiosurgery. Drugs include pasireotide (indicated for CD), mifepristone (indicated to control hyperglycemia secondary to hypercortisolism in patients with Cushing's syndrome) as well as several off-label treatments (ketoconazole, cabergoline, mitotane). Scenario 2 considers costs solely from the perspective of a health plan pharmacy. Costs are in $2013. Results:The estimated total budget impact is $0.0115 per-member per-month (PMPM) in the first year following FDA approval, $0.0184 in the second year, and $0.0194 in the third year. Introduction of pasireotide is expected to increase the pharmacy budget by $0.0257 PMPM in the first year, $0.0363 in the second year, and $0.0360 in the third year. Limitations:Model inputs rely on the small body of literature available for Cushing's disease. Conclusions:Cushing's disease is severe disease with debilitating comorbidities and substantial healthcare costs when untreated or inadequately controlled. The inclusion of pasireotide in a health plan formulary appears to have only a small impact on the total health plan or pharmacy budget.

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“…In a review of the use of SRS for pituitary adenomas, Laws and colleagues 20 examined 22 studies for CD and found that of those with at least 10 patients and a median follow-up of 2 years, the endocrinological cure rates ranged from 17 to 83%. Castinetti et al 3 reported that with Gamma Knife radiosurgery for CD a 40% remission rate was seen in 40 patients with a median follow-up of 54 months. Similar to other hormone secreting adenomas, the effects of radiation in CD make take up to 2 years to normalize the ACTH.…”

Section: Cushing Diseasementioning

confidence: 99%

Radiation therapy in the treatment of pituitary tumors

Ghostine

Johnson³

2008

FOC

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✓ The treatment of pituitary tumors has progressed into a multidisciplinary approach that involves neurosurgeons, radiation oncologists, and endocrinologists. This has allowed improved outcomes in treatment of pituitary tumors due to a combination of surgical, medical, and radiation therapies. In this study, the authors review the role of radiation therapy in the treatment of pituitary adenomas.

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Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Cited by 161 publications

References 29 publications

Radiotherapy and radiosurgery for Cushing's disease

Radiotherapy and radiosurgery for Cushing's disease

Budget impact of pasireotide for the treatment of Cushing’s disease, a rare endocrine disorder associated with considerable comorbidities

Radiation therapy in the treatment of pituitary tumors

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