Outcomes After Gamma Knife Stereotactic Radiosurgery in Pediatric Patients with Cushing Disease or Acromegaly: A Multi-Institutional Study

Shrivastava, Adesh; Mohammed, Nasser; Xu, Zhiyuan; Kosák, Mikuláš; Kršek, Michal; Karim, Khaled Abdel; Lee, Cheng‐Chia; Martínez-Moreno, Nuria; Vance, Mary Lee; Lunsford, L. Dade; Sheehan, Jason P.

doi:10.1016/j.wneu.2019.01.252

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…Remission of the hypercortisolism occurred in 87.5% of subjects after a mean interval of 12 months with 20% developing new pituitary hormone deficiencies related to the RT. [85] The rapid response of corticotroph adenomas to external RT was first documented in 1977 [86]. In 1985, external RT was delivered to 8 paediatric patients using a stereotactic technique delivering 50-70 Gy and inducing remission in 88% [87].…”

Section: Pituitary Radiotherapy (Rt)mentioning

confidence: 99%

“…In paediatric CD patients, gamma knife stereotactic radiosurgery was reported in 24 patients aged 10 to 21 years from a multi-national study [ 85 ]. Although precise details of the adenomas are not given, 18/24 patients had previously been treated unsuccessfully with TSS and 8 had cavernous sinus invasion by the adenoma, suggesting that these were not typical corticotroph microadenomas.…”

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

“…Remission of the hypercortisolism occurred in 87.5% of subjects after a mean interval of 12 months with 20% developing new pituitary hormone deficiencies related to the RT. [ 85 ]…”

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

“…However, the degree of individual hormone deficiencies is variable. Short-term GHD occurred most commonly [ 85 – 87 , 89 ], being present in 86% of patients reported by Storr et al Follow-up for a mean period of 10 years in the same patients showed that 3/4 boys regained normal GH secretion (Peak GH >10 ng/ml) [ 46 ]. It may be incorrect to attribute anterior pituitary deficiencies to RT alone because TSS induces GHD [ 78 ].…”

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

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Paediatric Cushing’s disease: Epidemiology, pathogenesis, clinical management and outcome

Ferrigno

Hasenmajer

Caiulo

et al. 2021

Rev Endocr Metab Disord

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Cushing’s disease (CD) is rare in paediatric practice but requires prompt investigation, diagnosis and therapy to prevent long-term complications. Key presenting features are a change in facial appearance, weight gain, growth failure, virilization, disturbed puberty and psychological disturbance. Close consultation with an adult endocrinology department is recommended regarding diagnosis and therapy. The incidence of CD, a form of ACTH-dependent Cushing’s syndrome (CS), is equal to approximately 5% of that seen in adults. The majority of ACTH-secreting adenomas are monoclonal and sporadic, although recent studies of pituitary tumours have shown links to several deubiquitination gene defects. Diagnosis requires confirmation of hypercortisolism followed by demonstration of ACTH-dependence. Identification of the corticotroph adenoma by pituitary MRI and/or bilateral inferior petrosal sampling for ACTH may contribute to localisation before pituitary surgery. Transsphenoidal surgery (TSS) with selective microadenomectomy is first-line therapy, followed by external pituitary irradiation if surgery is not curative. Medical therapy to suppress adrenal steroid synthesis is effective in the short-term and bilateral adrenalectomy should be considered in cases unfit for TSS or radiotherapy or when urgent remission is needed after unsuccessful surgery. TSS induces remission of hypercortisolism and improvement of symptoms in 70–100% of cases, particularly when performed by a surgeon with experience in children. Post-TSS complications include pituitary hormone deficiencies, sub-optimal catch-up growth, and persisting excess of BMI. Recurrence of hypercortisolism following remission is recognised but infrequent, being less common than in adult CD patients. With experienced specialist medical and surgical care, the overall prognosis is good. Early referral to an experienced endocrine centre is advised.

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Section: Pituitary Radiotherapy (Rt)mentioning

confidence: 99%

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

“…Remission of the hypercortisolism occurred in 87.5% of subjects after a mean interval of 12 months with 20% developing new pituitary hormone deficiencies related to the RT. [ 85 ]…”

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

Section: Treatment Of Paediatric Cushing’s Diseasementioning

confidence: 99%

See 2 more Smart Citations

Paediatric Cushing’s disease: Epidemiology, pathogenesis, clinical management and outcome

Ferrigno

Hasenmajer

Caiulo

et al. 2021

Rev Endocr Metab Disord

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“…The general protocol for Gamma Knife SRS has been previously described. 16,17 Briefly, with the patient under local or monitored anesthesia, a Leksell model G stereotactic frame (Elekta AB) was affixed to the calvaria. The CyberKnife SRS procedure was frameless and performed without anesthesia.…”

Section: Srs Techniquementioning

confidence: 99%

Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study

Hung

Lee

Yang

et al. 2021

Journal of Neurosurgery

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OBJECTIVECentral neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors.METHODSThe authors retrospectively analyzed a cohort of patients with CNs treated with SRS at 10 centers between 1994 and 2018. Tumor recurrences were classified as local or distant. Adverse radiation effects (AREs) and the need for a CSF shunt were also evaluated.RESULTSThe study cohort comprised 60 patients (median age 30 years), 92% of whom had undergone prior resection or biopsy and 8% received their diagnosis based on imaging alone. The median tumor volume and margin dose were 5.9 cm3 and 13 Gy, respectively. After a median clinical follow-up of 61 months, post-SRS tumor recurrence occurred in 8 patients (13%). The 5- and 10-year local tumor control rates were 93% and 87%, respectively. The 5- and 10-year progression-free survival rates were 89% and 80%, respectively. AREs were observed in 4 patients (7%), but only 1 was symptomatic (2%). Two patients underwent post-SRS tumor resection (3%). Prior radiotherapy was a predictor of distant tumor recurrence (p = 0.044). Larger tumor volume was associated with pre-SRS shunt surgery (p = 0.022).CONCLUSIONSTreatment of appropriately selected CNs with SRS achieves good tumor control rates with a reasonable complication profile. Distant tumor recurrence and dissemination were observed in a small proportion of patients, which underscores the importance of close post-SRS surveillance of CN patients. Patients with larger CNs are more likely to require shunt surgery before SRS.

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Pediatric Radiosurgery

Bernier-Chastagner¹

2020

CyberKnife NeuroRadiosurgery

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Outcomes After Gamma Knife Stereotactic Radiosurgery in Pediatric Patients with Cushing Disease or Acromegaly: A Multi-Institutional Study

Cited by 14 publications

References 24 publications

Paediatric Cushing’s disease: Epidemiology, pathogenesis, clinical management and outcome

Paediatric Cushing’s disease: Epidemiology, pathogenesis, clinical management and outcome

Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study

Pediatric Radiosurgery

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