Radiosurgery for Cushing's disease after failed transsphenoidal surgery

Sheehan, Jonas M.; Vance, Mary Lee; Sheehan, Jason P.; Ellegala, Dilantha B.; Laws, Edward R.

doi:10.3171/jns.2000.93.5.0738

Cited by 234 publications

(129 citation statements)

References 31 publications

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“…During long-term follow-up, our patients showed no increase in tumor volume, as observed in other series (14,15,17). We did not systematically monitor tumor size as the treatment was not primarily aimed at reducing target volume, which was most of the time a small remnant or a small enclosed macroadenoma.…”

Section: Discussionsupporting

confidence: 69%

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

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

161

118

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Objective: Though transsphenoidal surgery remains the first-line treatment of Cushing's disease, recurrence occurs frequently. Conventional radiotherapy and anticortisolic drugs both have adverse effects. Stereotactic radiosurgery needs to be evaluated more precisely. The aim of this study was to determine long-term hormonal effects and tolerance of gamma knife (GK) radiosurgery in Cushing's disease. Design: Forty patients with Cushing's disease treated by GK were prospectively studied over a decade, with a mean follow-up of 54.7 months. Eleven of them were treated with GK as a primary treatment. Methods: Radiosurgery was performed at the Department of Functional Neurosurgery of Marseille, France, using the Leksell Gamma Unit B and C models. Median margin dose was 29.5 Gy. Patients were considered in remission if they had normalized 24-h free urinary cortisol and suppression of plasma cortisol after low-dose dexamethasone suppression test. Results: Seventeen patients (42.5%) were in remission after a mean of 22 months (range 12-48 months). The two groups did not differ in terms of initial hormonal levels. Target volume was significantly higher in uncured than in remission group (909.8 vs 443 mm 3 , PZ0.038). We found a significant difference between patients who were on or off anticortisolic drugs at the time of GK (20 vs 48% patients in remission respectively, PZ0.02). Conclusion: With 42% of patients in remission after a median follow-up of 54 months, GK stereotactic radiosurgery, especially as an adjunctive treatment to surgery, may represent an alternative to other therapeutic options in view of their adverse effects.European Journal of Endocrinology 156 91-98

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Section: Discussionsupporting

confidence: 69%

“…Endocrinological 'cure' rates varied from 17 to 83%, with highly heterogeneous criteria of remission, and most studies were based on short-term effects of GK (14)(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

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

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

161

118

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show abstract

“…Mauermann et al 32 reported no change or a reduction in tumor size in 20 of 22 patients following treatment for adrenocorticotropic hormone-producing adenomas in patients with adrenalectomies; there were variable adrenocorticotropic hormone results. Sheehan et al 44 reported that GKS was effective in patients with Cushing disease following failed transsphenoidal surgery.…”

Section: Pituitary Tumorsmentioning

confidence: 99%

Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

Johnson

Loredo

Slater

2008

FOC

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✓ Historically, radiation therapy has been used extensively in the treatment of malignant and aggressive intracranial tumors, and the importance of its role has been repeatedly verified by prolonged patient survival rates and increased tumor control. As more modern capabilities are employed in surgery and radiotherapy, attention is being directed to the utility of radiation as either primary or secondary treatment of benign tumors. Specifically, primary treatment encompasses irradiation of small benign tumors without biopsy confirmation of tumor type; secondary treatment involves postoperative radiation therapy, with the possibility that less-aggressive tumor resection may be performed in areas that have a higher probability of resultant neurological deficit. Current literature suggests that this is not only a possible treatment strategy, but that it may be superior to more radical resection in some cases, for example, in vestibular schwannomas and meningiomas. This article provides an overview of factors to consider in the use of radiation therapy and reviews the relationships between radiation and surgery, notably the unique complementary role each plays in the treatment of benign intracranial tumors.

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“…9 Tumor control after GKS is greater than 90% in most functioning adenoma series. 2,5,[7][8][9] However, endocrine remission rates vary from 40% to 80%. 2,5,[7][8][9] This disparity between tumor control and endocrine remission underscores an opportunity for significant improvement in outcomes.…”

Section: Disclosurementioning

confidence: 99%

“…2,5,[7][8][9] However, endocrine remission rates vary from 40% to 80%. 2,5,[7][8][9] This disparity between tumor control and endocrine remission underscores an opportunity for significant improvement in outcomes. Avenues for such improvement will probably occur through pharmacological alterations in the tumor biology, allowing for enhanced target delineation on neuroimaging studies and a more favorable response to ionizing radiation.…”

Section: Disclosurementioning

confidence: 99%

Editorial: Cushing's disease and stereotactic radiosurgery

Kondziolka

2013

JNS

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Radiosurgery for Cushing's disease after failed transsphenoidal surgery

Abstract: Gamma knife radiosurgery appears to be safe and effective for the treatment of Cushing's disease refractory to pituitary surgery. Delayed recurrences and new hormone deficiencies may occur, indicating the necessity for regular long-term follow up.

Cited by 234 publications

References 31 publications

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

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

Surgery and radiotherapy: complementary tools in the management of benign intracranial tumors

Editorial: Cushing's disease and stereotactic radiosurgery

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