Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study

Mehta, Gautam U.; Ding, Dale; Patibandla, Mohana Rao; Kano, Hideyuki; Sisterson, Nathaniel D; Su, Yan-Hua; Kršek, Michal; Nabeel, Ahmed M; El-Shehaby, Amr M N; Kareem, Khaled A; Martínez-Moreno, Nuria; Mathieu, David; McShane, Brendan; Blas, Kevin; Kondziolka, Douglas; Grills, I.S.; Lee, John Y.; Martínez‐Álvarez, Roberto; Reda, Wael A; Liščák, Roman; Lee, Cheng‐Chia; Lunsford, L. Dade; Vance, Mary Lee; Sheehan, Jason P.

doi:10.1210/jc.2017-01385

Cited by 85 publications

(90 citation statements)

References 31 publications

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“…Stereotactic methods have become a good alternative for human patients who are poor surgical candidates due to high control rates and relatively high rates of remission for Cushing's cases compared to definitive radiation, and with similar stereotactic fractionation schemes as in veterinary medicine . It is interesting that the canine cases in our study appeared to have shorter survivals than with conventional fractionated radiation in the dog.…”

Section: Discussionmentioning

confidence: 99%

Long‐term survival with stereotactic radiotherapy for imaging‐diagnosed pituitary tumors in dogs

Hansen

Zwingenberger

Théon

et al. 2018

Vet Radiology Ultrasound

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Published studies on the use of stereotactic radiotherapy for dogs with pituitary tumors are limited. This retrospective observational study describes results of stereotactic radiotherapy for 45 dogs with imaging-diagnosed pituitary tumors. All dogs were treated at a single hospital during the period of December 2009-2015. The stereotactic radiotherapy was delivered in one 15 Gray (Gy) fraction or in three 8 Gy fractions. At the time of analysis, 41 dogs were deceased.Four were alive and censored from all survival analyses; one dog received 8 Gy every other day and was removed from protocol analyses. The median overall survival from first treatment was 311 days (95% confidence interval 226-410 days [range 1-2134 days]). Thirty-two dogs received 15 Gy (median overall survival 311 days; 95% confidence interval [range 221-427 days]), and 12 received 24 Gy on three consecutive days (median overall survival 245 days, 95% confidence interval [range 2-626 days]). Twenty-nine dogs had hyperadrenocorticism (median overall survival 245 days), while 16 had nonfunctional masses (median overall survival 626 days). Clinical improvement was reported in 37/45 cases. Presumptive signs of acute adverse effects within 4 months of stereotactic radiotherapy were noted in 10/45, and most had improvement spontaneously or with steroids. Late effects versus tumor progression were not discernable, but posttreatment blindness (2), hypernatremia (2), and progressive neurological signs (31) were reported.There was no statistical difference in median overall survival for different protocols. Patients with nonfunctional masses had longer median overall survival than those with hyperadrenocorticism (P = 0.0003). Survival outcomes with stereotactic radiotherapy were shorter than those previously reported with definitive radiation, especially for dogs with hyperadrenocorticism. K E Y W O R D SCushing's disease, hyperadrenocorticism, photon therapy, SRS, stereotaxis three-dimensional-conformal fields, or with a cone-based system for beam collimation. 17,18,25 There is one study of 51 dogs with

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Section: Discussionmentioning

confidence: 99%

Long‐term survival with stereotactic radiotherapy for imaging‐diagnosed pituitary tumors in dogs

Hansen

Zwingenberger

Théon

et al. 2018

Vet Radiology Ultrasound

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“…For instance, in the CD and acromegaly studies by our group, as well as a review of the literature, we have not seen a single instance of symptomatic carotid stenosis leading to cerebral ischemia. 2,6,7 This sharply contrasts with radiotherapy series for patients with pituitary adenoma. 1 The same is true for radiation-induced neoplasia and neurocognitive deficits after radiosurgery as compared with radiotherapy for tumors of the sella.…”

Section: Responsementioning

confidence: 94%

“…1 In one study from the Mayo Clinic the investigators also believe that the risk of delayed hypopituitarism caused by radiotherapy is significant. 6 The risk of this hypopituitarism exists for a lifetime. 9 It is therefore recommended that this article add age factors when deriving the conclusion of efficacy for upfront GKS for CD and acromegaly treatment.…”

Section: Upfront Gks For Cushing's Disease and Acromegaly: Is It Suitmentioning

confidence: 99%

“…The current study cohorts represent a small subset of patients published in our previous studies. 2,6 Previous series provide evidence that radiosurgery appears to achieve more rapid remission than fractionated radiotherapy. 5 Among functioning pituitary adenomas, there is evidence to support differences in radiosurgical sensitivity in secretory adenomas, as measured by hormone release.…”

Section: Responsementioning

confidence: 99%

“…Until then, the pituitary adenoma radiosurgery studies by the International Radiosurgery Research Foundation (IRRF) will probably remain the highest level of evidence available to guide clinicians. 2,6…”

Section: Responsementioning

confidence: 99%

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Letter to the Editor. Upfront GKS for Cushing’s disease and acromegaly: is it suitable?

Gao

Xing

2019

Journal of Neurosurgery

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The authors included 21 patients with Cushing's disease (CD) and 25 patients with acromegaly undergoing upfront Gamma Knife radiosurgery (GKS). After a median endocrine follow-up of 69.5 months, patients with CD achieved a faster and far better remission rate compared to patients with acromegaly. The authors suggest a possible differential radiosensitivity of two kinds, and then further recommend upfront GKS in CD rather than in acromegaly. We commend the efforts of the authors in carrying out this interesting study. Yet from the perspective of neurosurgeons, some conclusions are questionable.The biggest concern lies in the posttreatment remission criteria for CD that were used in this study. The authors defined remission as normalization of urinary free cortisol and morning serum cortisol levels, which is not recognized by most endocrinologists and neurosurgeons. According to the latest Endocrine Society Clinical Practice Guideline for CD, as well as other previous literature, remission is generally defined as morning serum cortisol values < 5 μg/dl, a stricter criterion than just normal range. 2,5,7 One meta-analysis suggests that patients with CD in whom subnormal cortisol levels are found after treatment have a clearly lower risk of long-term recurrence compared to those within the normal range. 8 The reduction of cortisol levels to the normal range after treatment does not necessarily represent the patient's cure, but rather a higher recurrence rate. 9 Regarding this condition as remission could give patients overly optimistic and misleading expectations, and may cause neglect of follow-up. Moreover, the use of different remission criteria hinders direct comparison of outcomes between this GKS study and other surgical treatment studies for CD.Nevertheless, although the authors have used more easily achievable remission criteria for CD, the remission criteria for acromegaly (i.e., growth hormone [GH] level < 1 ng/ml in response to a glucose challenge) are much stricter and in accordance with the latest guideline. 4 These varying degrees of rigor in criteria to assess CD and acromegaly may also make less convincing the conclusion that patients with CD achieve faster and better remission rates and that their disease is more sensitive to GKS than is the case in those with acromegaly.In addition, this study did not mention the impact of radiotherapy on the growth of younger patients, especially when the youngest patient with CD included in this study was 14 years old. A radiotherapy study in pediatric CD reported that the incidence of GH deficiency after radiation therapy was 36%-68%, and most patients failed to reach the target height. 1 In one study from the Mayo Clinic the investigators also believe that the risk of delayed hypopituitarism caused by radiotherapy is significant. 6 The risk of this hypopituitarism exists for a lifetime. 9 It is therefore recommended that this article add age factors when deriving the conclusion of efficacy for upfront GKS for CD and acromegaly treatment. Especially given the lac...

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Neoplasms of the Endocrine Glands and Pituitary Neoplasms

Feng¹,

Gandhi²,

Pain³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview Pituitary neoplasms represent a phenotypically and pathologically diverse family of tumors. Symptoms may derive from abnormal hormone production, compression of adjacent nervous system structures, and in rare cases, metastases. New cell lineage classification based on transcription factors brings new insights into pathogenesis and treatment. Transsphenoidal surgery represents a command well‐tolerated treatment for most pituitary adenomas; however, advances in radiation and chemotherapy have increased treatment options enhancing treatment efficacy and eligibility.

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Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study

Cited by 85 publications

References 31 publications

Long‐term survival with stereotactic radiotherapy for imaging‐diagnosed pituitary tumors in dogs

Long‐term survival with stereotactic radiotherapy for imaging‐diagnosed pituitary tumors in dogs

Letter to the Editor. Upfront GKS for Cushing’s disease and acromegaly: is it suitable?

Neoplasms of the Endocrine Glands and Pituitary Neoplasms

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