Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing Disease: Results from a Multicenter, International Cohort Study

World Neurosurgery
Matthew J ShepardJason Sheehan

Abstract

Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS. An international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS. A total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm3, and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were iden...Continue Reading

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Citations

Nov 1, 2018·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Nathaniel D SistersonR Mark Richardson
Apr 11, 2019·European Journal of Endocrinology·Frederic CastinettiOskar Ragnarsson
Nov 8, 2019·Clinical Endocrinology·Kunal ThakkarNalini S Shah
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Aug 20, 2020·Expert Review of Endocrinology & Metabolism·Cristina CapatinaMaria Fleseriu
Apr 6, 2021·Best Practice & Research. Clinical Endocrinology & Metabolism·Monica Livia Gheorghiu
Jun 8, 2021·AACE Clinical Case Reports·Christine Mathai, Jonathan Anolik

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