Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study
Abstract Context Cushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge. Objective To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management. Design International, multicenter, retrospective...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2017-11, Vol.102 (11), p.4284-4291 |
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| creator | Mehta, Gautam U Ding, Dale Patibandla, Mohana Rao Kano, Hideyuki Sisterson, Nathaniel Su, Yan-Hua Krsek, Michal Nabeel, Ahmed M El-Shehaby, Amr Kareem, Khaled A Martinez-Moreno, Nuria Mathieu, David McShane, Brendan Blas, Kevin Kondziolka, Douglas Grills, Inga Lee, John Y Martinez-Alvarez, Roberto Reda, Wael A Liscak, Roman Lee, Cheng-Chia Lunsford, L Dade Vance, Mary Lee Sheehan, Jason P |
| description | Abstract
Context
Cushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge.
Objective
To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management.
Design
International, multicenter, retrospective cohort analysis.
Setting
Ten medical centers participating in the International Gamma Knife Research Foundation.
Patients
Patients with CD with >6 months endocrine follow-up.
Intervention
SRS using Gamma Knife radiosurgery.
Main Outcome Measures
The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded.
Results
In total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation.
Conclusions
SRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS.
We studied the outcomes of stereotactic radiosurgery for Cushing disease in 278 patients and found that this treatment can result in durable endocrine remission in appropriately selected patients. |
| doi_str_mv | 10.1210/jc.2017-01385 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1942702885</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1210/jc.2017-01385</oup_id><sourcerecordid>2030622760</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5015-4095617bb1228d045b94953e6e983d15b61820e9543bd0669cdb81e03f59ed413</originalsourceid><addsrcrecordid>eNp1kE1v1DAQhi0EotvCkSuyxIUDKeOvxOaGFgqVipBakLggy3Em3SzZeLFjVfvv8bJbDpU4jTTzzDuah5AXDM4ZZ_B27c85sKYCJrR6RBbMSFU1zDSPyQKAs8o0_McJOU1pDcCkVOIpOeHaCC1rviA_b2aMGGbn58HTa9cNIeV4i3FH-xDpMqfVMN3SD0NCl_AdvcaUxznR0FM30cupbE9uHsLkxjf0SxkNHvdNejPnbveMPOndmPD5sZ6R7xcfvy0_V1dfP10u319VXgFTlQSjata0LeNcdyBVa6RRAms0WnRMtTXTHNAoKdoO6tr4rtUMQfTKYCeZOCOvD7nbGH5nTLPdDMnjOLoJQ062SOENcK1VQV89QNchlx_GZDkIqDlvaihUdaB8DClF7O02DhsXd5aB3Xu3a2_33u1f74V_eUzN7Qa7f_S96AKwA3AXxqIn_RrzHUa7QjfOq4eh1X3o8auQt_-7f0T_AAP9mD4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2030622760</pqid></control><display><type>article</type><title>Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study</title><source>ProQuest One Community College</source><source>MEDLINE</source><source>ProQuest Central (Alumni Edition)</source><source>Journals@Ovid Complete</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>ProQuest Central UK/Ireland</source><source>Alma/SFX Local Collection</source><source>ProQuest Central</source><creator>Mehta, Gautam U ; Ding, Dale ; Patibandla, Mohana Rao ; Kano, Hideyuki ; Sisterson, Nathaniel ; Su, Yan-Hua ; Krsek, Michal ; Nabeel, Ahmed M ; El-Shehaby, Amr ; Kareem, Khaled A ; Martinez-Moreno, Nuria ; Mathieu, David ; McShane, Brendan ; Blas, Kevin ; Kondziolka, Douglas ; Grills, Inga ; Lee, John Y ; Martinez-Alvarez, Roberto ; Reda, Wael A ; Liscak, Roman ; Lee, Cheng-Chia ; Lunsford, L Dade ; Vance, Mary Lee ; Sheehan, Jason P</creator><creatorcontrib>Mehta, Gautam U ; Ding, Dale ; Patibandla, Mohana Rao ; Kano, Hideyuki ; Sisterson, Nathaniel ; Su, Yan-Hua ; Krsek, Michal ; Nabeel, Ahmed M ; El-Shehaby, Amr ; Kareem, Khaled A ; Martinez-Moreno, Nuria ; Mathieu, David ; McShane, Brendan ; Blas, Kevin ; Kondziolka, Douglas ; Grills, Inga ; Lee, John Y ; Martinez-Alvarez, Roberto ; Reda, Wael A ; Liscak, Roman ; Lee, Cheng-Chia ; Lunsford, L Dade ; Vance, Mary Lee ; Sheehan, Jason P</creatorcontrib><description>Abstract
Context
Cushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge.
Objective
To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management.
Design
International, multicenter, retrospective cohort analysis.
Setting
Ten medical centers participating in the International Gamma Knife Research Foundation.
Patients
Patients with CD with >6 months endocrine follow-up.
Intervention
SRS using Gamma Knife radiosurgery.
Main Outcome Measures
The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded.
Results
In total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation.
Conclusions
SRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS.
We studied the outcomes of stereotactic radiosurgery for Cushing disease in 278 patients and found that this treatment can result in durable endocrine remission in appropriately selected patients.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2017-01385</identifier><identifier>PMID: 28938462</identifier><language>eng</language><publisher>Washington, DC: Endocrine Society</publisher><subject>ACTH-Secreting Pituitary Adenoma - secretion ; ACTH-Secreting Pituitary Adenoma - surgery ; Adenoma - secretion ; Adenoma - surgery ; Adolescent ; Adrenocorticotropic hormone ; Adult ; Aged ; Aged, 80 and over ; Brain tumors ; Child ; Cushing syndrome ; Cushing's disease ; Female ; Follow-Up Studies ; Health care facilities ; Hormones ; Humans ; Hydrocortisone ; Hypopituitarism ; Irradiation ; Male ; Middle Aged ; Nervous system diseases ; Neuropathy ; Patients ; Pituitary ; Pituitary ACTH Hypersecretion - surgery ; Radiation ; Radiology ; Radiosurgery ; Radiosurgery - methods ; Remission ; Retrospective Studies ; Skull ; Surgery ; Treatment Outcome ; Young Adult</subject><ispartof>The journal of clinical endocrinology and metabolism, 2017-11, Vol.102 (11), p.4284-4291</ispartof><rights>Copyright © 2017 Endocrine Society 2017</rights><rights>Copyright © Oxford University Press 2015</rights><rights>Copyright © 2017 Endocrine Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5015-4095617bb1228d045b94953e6e983d15b61820e9543bd0669cdb81e03f59ed413</citedby><cites>FETCH-LOGICAL-c5015-4095617bb1228d045b94953e6e983d15b61820e9543bd0669cdb81e03f59ed413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2030622760?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33531,33744,33745,43659,43805,64385,64387,64389,72469,73123,73128,73129,73131</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28938462$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehta, Gautam U</creatorcontrib><creatorcontrib>Ding, Dale</creatorcontrib><creatorcontrib>Patibandla, Mohana Rao</creatorcontrib><creatorcontrib>Kano, Hideyuki</creatorcontrib><creatorcontrib>Sisterson, Nathaniel</creatorcontrib><creatorcontrib>Su, Yan-Hua</creatorcontrib><creatorcontrib>Krsek, Michal</creatorcontrib><creatorcontrib>Nabeel, Ahmed M</creatorcontrib><creatorcontrib>El-Shehaby, Amr</creatorcontrib><creatorcontrib>Kareem, Khaled A</creatorcontrib><creatorcontrib>Martinez-Moreno, Nuria</creatorcontrib><creatorcontrib>Mathieu, David</creatorcontrib><creatorcontrib>McShane, Brendan</creatorcontrib><creatorcontrib>Blas, Kevin</creatorcontrib><creatorcontrib>Kondziolka, Douglas</creatorcontrib><creatorcontrib>Grills, Inga</creatorcontrib><creatorcontrib>Lee, John Y</creatorcontrib><creatorcontrib>Martinez-Alvarez, Roberto</creatorcontrib><creatorcontrib>Reda, Wael A</creatorcontrib><creatorcontrib>Liscak, Roman</creatorcontrib><creatorcontrib>Lee, Cheng-Chia</creatorcontrib><creatorcontrib>Lunsford, L Dade</creatorcontrib><creatorcontrib>Vance, Mary Lee</creatorcontrib><creatorcontrib>Sheehan, Jason P</creatorcontrib><title>Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Abstract
Context
Cushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge.
Objective
To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management.
Design
International, multicenter, retrospective cohort analysis.
Setting
Ten medical centers participating in the International Gamma Knife Research Foundation.
Patients
Patients with CD with >6 months endocrine follow-up.
Intervention
SRS using Gamma Knife radiosurgery.
Main Outcome Measures
The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded.
Results
In total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation.
Conclusions
SRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS.
We studied the outcomes of stereotactic radiosurgery for Cushing disease in 278 patients and found that this treatment can result in durable endocrine remission in appropriately selected patients.</description><subject>ACTH-Secreting Pituitary Adenoma - secretion</subject><subject>ACTH-Secreting Pituitary Adenoma - surgery</subject><subject>Adenoma - secretion</subject><subject>Adenoma - surgery</subject><subject>Adolescent</subject><subject>Adrenocorticotropic hormone</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain tumors</subject><subject>Child</subject><subject>Cushing syndrome</subject><subject>Cushing's disease</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health care facilities</subject><subject>Hormones</subject><subject>Humans</subject><subject>Hydrocortisone</subject><subject>Hypopituitarism</subject><subject>Irradiation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nervous system diseases</subject><subject>Neuropathy</subject><subject>Patients</subject><subject>Pituitary</subject><subject>Pituitary ACTH Hypersecretion - surgery</subject><subject>Radiation</subject><subject>Radiology</subject><subject>Radiosurgery</subject><subject>Radiosurgery - methods</subject><subject>Remission</subject><subject>Retrospective Studies</subject><subject>Skull</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1v1DAQhi0EotvCkSuyxIUDKeOvxOaGFgqVipBakLggy3Em3SzZeLFjVfvv8bJbDpU4jTTzzDuah5AXDM4ZZ_B27c85sKYCJrR6RBbMSFU1zDSPyQKAs8o0_McJOU1pDcCkVOIpOeHaCC1rviA_b2aMGGbn58HTa9cNIeV4i3FH-xDpMqfVMN3SD0NCl_AdvcaUxznR0FM30cupbE9uHsLkxjf0SxkNHvdNejPnbveMPOndmPD5sZ6R7xcfvy0_V1dfP10u319VXgFTlQSjata0LeNcdyBVa6RRAms0WnRMtTXTHNAoKdoO6tr4rtUMQfTKYCeZOCOvD7nbGH5nTLPdDMnjOLoJQ062SOENcK1VQV89QNchlx_GZDkIqDlvaihUdaB8DClF7O02DhsXd5aB3Xu3a2_33u1f74V_eUzN7Qa7f_S96AKwA3AXxqIn_RrzHUa7QjfOq4eh1X3o8auQt_-7f0T_AAP9mD4</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Mehta, Gautam U</creator><creator>Ding, Dale</creator><creator>Patibandla, Mohana Rao</creator><creator>Kano, Hideyuki</creator><creator>Sisterson, Nathaniel</creator><creator>Su, Yan-Hua</creator><creator>Krsek, Michal</creator><creator>Nabeel, Ahmed M</creator><creator>El-Shehaby, Amr</creator><creator>Kareem, Khaled A</creator><creator>Martinez-Moreno, Nuria</creator><creator>Mathieu, David</creator><creator>McShane, Brendan</creator><creator>Blas, Kevin</creator><creator>Kondziolka, Douglas</creator><creator>Grills, Inga</creator><creator>Lee, John Y</creator><creator>Martinez-Alvarez, Roberto</creator><creator>Reda, Wael A</creator><creator>Liscak, Roman</creator><creator>Lee, Cheng-Chia</creator><creator>Lunsford, L Dade</creator><creator>Vance, Mary Lee</creator><creator>Sheehan, Jason P</creator><general>Endocrine Society</general><general>Copyright Oxford University Press</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study</title><author>Mehta, Gautam U ; Ding, Dale ; Patibandla, Mohana Rao ; Kano, Hideyuki ; Sisterson, Nathaniel ; Su, Yan-Hua ; Krsek, Michal ; Nabeel, Ahmed M ; El-Shehaby, Amr ; Kareem, Khaled A ; Martinez-Moreno, Nuria ; Mathieu, David ; McShane, Brendan ; Blas, Kevin ; Kondziolka, Douglas ; Grills, Inga ; Lee, John Y ; Martinez-Alvarez, Roberto ; Reda, Wael A ; Liscak, Roman ; Lee, Cheng-Chia ; Lunsford, L Dade ; Vance, Mary Lee ; Sheehan, Jason P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5015-4095617bb1228d045b94953e6e983d15b61820e9543bd0669cdb81e03f59ed413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>ACTH-Secreting Pituitary Adenoma - secretion</topic><topic>ACTH-Secreting Pituitary Adenoma - surgery</topic><topic>Adenoma - secretion</topic><topic>Adenoma - surgery</topic><topic>Adolescent</topic><topic>Adrenocorticotropic hormone</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain tumors</topic><topic>Child</topic><topic>Cushing syndrome</topic><topic>Cushing's disease</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health care facilities</topic><topic>Hormones</topic><topic>Humans</topic><topic>Hydrocortisone</topic><topic>Hypopituitarism</topic><topic>Irradiation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nervous system diseases</topic><topic>Neuropathy</topic><topic>Patients</topic><topic>Pituitary</topic><topic>Pituitary ACTH Hypersecretion - surgery</topic><topic>Radiation</topic><topic>Radiology</topic><topic>Radiosurgery</topic><topic>Radiosurgery - methods</topic><topic>Remission</topic><topic>Retrospective Studies</topic><topic>Skull</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehta, Gautam U</creatorcontrib><creatorcontrib>Ding, Dale</creatorcontrib><creatorcontrib>Patibandla, Mohana Rao</creatorcontrib><creatorcontrib>Kano, Hideyuki</creatorcontrib><creatorcontrib>Sisterson, Nathaniel</creatorcontrib><creatorcontrib>Su, Yan-Hua</creatorcontrib><creatorcontrib>Krsek, Michal</creatorcontrib><creatorcontrib>Nabeel, Ahmed M</creatorcontrib><creatorcontrib>El-Shehaby, Amr</creatorcontrib><creatorcontrib>Kareem, Khaled A</creatorcontrib><creatorcontrib>Martinez-Moreno, Nuria</creatorcontrib><creatorcontrib>Mathieu, David</creatorcontrib><creatorcontrib>McShane, Brendan</creatorcontrib><creatorcontrib>Blas, Kevin</creatorcontrib><creatorcontrib>Kondziolka, Douglas</creatorcontrib><creatorcontrib>Grills, Inga</creatorcontrib><creatorcontrib>Lee, John Y</creatorcontrib><creatorcontrib>Martinez-Alvarez, Roberto</creatorcontrib><creatorcontrib>Reda, Wael A</creatorcontrib><creatorcontrib>Liscak, Roman</creatorcontrib><creatorcontrib>Lee, Cheng-Chia</creatorcontrib><creatorcontrib>Lunsford, L Dade</creatorcontrib><creatorcontrib>Vance, Mary Lee</creatorcontrib><creatorcontrib>Sheehan, Jason P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehta, Gautam U</au><au>Ding, Dale</au><au>Patibandla, Mohana Rao</au><au>Kano, Hideyuki</au><au>Sisterson, Nathaniel</au><au>Su, Yan-Hua</au><au>Krsek, Michal</au><au>Nabeel, Ahmed M</au><au>El-Shehaby, Amr</au><au>Kareem, Khaled A</au><au>Martinez-Moreno, Nuria</au><au>Mathieu, David</au><au>McShane, Brendan</au><au>Blas, Kevin</au><au>Kondziolka, Douglas</au><au>Grills, Inga</au><au>Lee, John Y</au><au>Martinez-Alvarez, Roberto</au><au>Reda, Wael A</au><au>Liscak, Roman</au><au>Lee, Cheng-Chia</au><au>Lunsford, L Dade</au><au>Vance, Mary Lee</au><au>Sheehan, Jason P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2017-11</date><risdate>2017</risdate><volume>102</volume><issue>11</issue><spage>4284</spage><epage>4291</epage><pages>4284-4291</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><abstract>Abstract
Context
Cushing disease (CD) due to adrenocorticotropic hormone–secreting pituitary tumors can be a management challenge.
Objective
To better understand the outcomes of stereotactic radiosurgery (SRS) for CD and define its role in management.
Design
International, multicenter, retrospective cohort analysis.
Setting
Ten medical centers participating in the International Gamma Knife Research Foundation.
Patients
Patients with CD with >6 months endocrine follow-up.
Intervention
SRS using Gamma Knife radiosurgery.
Main Outcome Measures
The primary outcome was control of hypercortisolism (defined as normalization of free urinary cortisol). Radiologic response and adverse radiation effects (AREs) were recorded.
Results
In total, 278 patients met inclusion criteria, with a mean follow-up of 5.6 years (0.5 to 20.5 years). Twenty-two patients received SRS as a primary treatment of CD. Mean margin dose was 23.7 Gy. Cumulative initial control of hypercortisolism was 80% at 10 years. Mean time to cortisol normalization was 14.5 months. Recurrences occurred in 18% with initial cortisol normalization. Overall, the rate of durable control of hypercortisolism was 64% at 10 years and 68% among patients who received SRS as a primary treatment. AREs included hypopituitarism (25%) and cranial neuropathy (3%). Visual deficits were related to treatment of tumor within the suprasellar cistern (P = 0.01), whereas both visual (P < 0.0001) and nonvisual cranial neuropathy (P = 0.02) were related to prior pituitary irradiation.
Conclusions
SRS for CD is well tolerated and frequently results in control of hypercortisolism. However, recurrences can occur. SRS should be considered for patients with persistent hypercortisolism after pituitary surgery and as a primary treatment in those unfit for surgery. Long-term endocrine follow-up is essential after SRS.
We studied the outcomes of stereotactic radiosurgery for Cushing disease in 278 patients and found that this treatment can result in durable endocrine remission in appropriately selected patients.</abstract><cop>Washington, DC</cop><pub>Endocrine Society</pub><pmid>28938462</pmid><doi>10.1210/jc.2017-01385</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The journal of clinical endocrinology and metabolism, 2017-11, Vol.102 (11), p.4284-4291 |
| issn | 0021-972X 1945-7197 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1942702885 |
| source | ProQuest One Community College; MEDLINE; ProQuest Central (Alumni Edition); Journals@Ovid Complete; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; ProQuest Central UK/Ireland; Alma/SFX Local Collection; ProQuest Central |
| subjects | ACTH-Secreting Pituitary Adenoma - secretion ACTH-Secreting Pituitary Adenoma - surgery Adenoma - secretion Adenoma - surgery Adolescent Adrenocorticotropic hormone Adult Aged Aged, 80 and over Brain tumors Child Cushing syndrome Cushing's disease Female Follow-Up Studies Health care facilities Hormones Humans Hydrocortisone Hypopituitarism Irradiation Male Middle Aged Nervous system diseases Neuropathy Patients Pituitary Pituitary ACTH Hypersecretion - surgery Radiation Radiology Radiosurgery Radiosurgery - methods Remission Retrospective Studies Skull Surgery Treatment Outcome Young Adult |
| title | Stereotactic Radiosurgery for Cushing Disease: Results of an International, Multicenter Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T03%3A08%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Stereotactic%20Radiosurgery%20for%20Cushing%20Disease:%20Results%20of%20an%20International,%20Multicenter%20Study&rft.jtitle=The%20journal%20of%20clinical%20endocrinology%20and%20metabolism&rft.au=Mehta,%20Gautam%20U&rft.date=2017-11&rft.volume=102&rft.issue=11&rft.spage=4284&rft.epage=4291&rft.pages=4284-4291&rft.issn=0021-972X&rft.eissn=1945-7197&rft_id=info:doi/10.1210/jc.2017-01385&rft_dat=%3Cproquest_cross%3E2030622760%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2030622760&rft_id=info:pmid/28938462&rft_oup_id=10.1210/jc.2017-01385&rfr_iscdi=true |