The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Devin, Jessica K.; Allen, George S.; Cmelak, Anthony J.; Duggan, Dennis M.; Blevins, Lewis S.

doi:10.1159/000083476

Cited by 79 publications

(44 citation statements)

References 59 publications

(58 reference statements)

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“…Control of hypercortisolism in w43-83% of patients can be achieved within 8 months to 5 years (92,93,94). Hypopituitarism is the most common side effect of pituitary irradiation, with an incidence of 13-56% (91).…”

Section: Outcomes and Complications Of Current Treatment Optionsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

Feelders

Pulgar

Kempel³

et al. 2012

European Journal of Endocrinology

230

199

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Objective: Cushing's disease (CD) is a rare endocrine disorder characterized by excess secretion of ACTH due to a pituitary adenoma. Current treatment options are limited and may pose additional risks. A literature review was conducted to assess the holistic burden of CD. Design: Studies published in English were evaluated to address questions regarding the epidemiology of CD, time to diagnosis, health-related quality of life (HRQoL), treatment outcomes, mortality, prevalence of comorbidities at diagnosis, and reversibility of comorbidities following the treatment. Methods: A two-stage literature search was performed in Medline, EMBASE, and Science Citation Index, using keywords related to the epidemiology, treatment, and outcomes of CD: i) articles published from 2000 to 2012 were identified and ii) an additional hand search (all years) was conducted on the basis of bibliography of identified articles. Results: At the time of diagnosis, 58-85% of patients have hypertension, 32-41% are obese, 20-47% have diabetes mellitus, 50-81% have major depression, 31-50% have osteoporosis, and 38-71% have dyslipidemia. Remission rates following transsphenoidal surgery (TSS) are high when performed by expert pituitary surgeons (rates of 65-90%), but the potential for relapse remains (rates of 5-36%). Although some complications can be partially reversed, time to reversal can take years. The HRQoL of patients with CD also remains severely compromised after remission. Conclusions: These findings highlight the significant burden associated with CD. As current treatment options may not fully reverse the burden of chronic hypercortisolism, there is a need for both improved diagnostic tools to reduce the time to diagnosis and effective therapy, particularly a targeted medical therapy.

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Section: Outcomes and Complications Of Current Treatment Optionsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

Feelders

Pulgar

Kempel³

et al. 2012

European Journal of Endocrinology

230

199

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“…The reported tumour control in SRS studies in patients with Cushing's disease was 94% at a corrected median follow-up of 45 months (table 2) (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). This compares to the 5-year tumour control rate (progression free survival) in all pituitary adenomas of 91.5% (39)(40)(41)(42), which is worse than reported following fractionated RT even though the tumours treated are smaller.…”

Section: Radiosurgerymentioning

confidence: 77%

Radiotherapy and radiosurgery for Cushing's disease

Minniti

Brada

2007

Arq Bras Endocrinol Metab

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Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease. RESUMORadioterapia e Radiocirurgia para a Doença de Cushing. Pacientes com doença de Cushing residual ou recorrente recebem radioterapia externa em feixe (RT) com o objetivo de alcançar um controle tumoral prolongado e a normalização dos níveis hormonais elevados. O tratamento é realizado tanto com RT convencional, usando técnicas conformacionais, ou com RT estereotáxica, que é usada tanto como tratamento fracionado (RTF) ou como radiocirurgia em procedimento único (RCU). Descreveremos os aspectos técnicos do tratamento e mostraremos uma revisão sistemática da literatura sobre a eficácia e toxicidade da RT convencional, da RTF e da RCU. Não existem estudos comparando diretamente as diferentes técnicas de radiação, e os resultados reportados são inevitavelmente os de pacientes selecionados pelos investigadores com interesse no tratamento testado. De qualquer maneira, a revisão dos dados publicados sugere que há melhores taxas de controle hormonal e tumoral após RTF em comparação com RCU. O hipopituitarismo representa a complicação tardia mais comumente relatada da RT, vista após todos os tipos de tratamento. Embora a incidência de outros efeitos tardios seja baixa, o risco de a radiação comprometer estrutura...

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“…However, it can take years for radiotherapy to become effective, leaving the patients exposed to the toxic effects of cortisol excess. In addition, 30-40% of patients develop pituitary insufficiency after pituitary irradiation (Boscaro et al 2001, Devin et al 2004, Vance 2005, Petit et al 2008, Bertagna et al 2009, Tritos et al 2011. Medical treatment for patients with persistent or recurrent CD has the advantage over radiotherapy of a direct onset of action and preserving pituitary function.…”

Section: Cs Etiology Clinical Features and Therapeutic Approach Actmentioning

confidence: 99%

New developments in the medical treatment of Cushing's syndrome

Pas¹,

Herder²,

Hofland³

et al. 2012

Endocrine-Related Cancer

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Cushing's syndrome (CS) is a severe endocrine disorder characterized by chronic cortisol excess due to an ACTH-secreting pituitary adenoma, ectopic ACTH production, or a cortisol-producing adrenal neoplasia. Regardless of the underlying cause, untreated CS is associated with considerable morbidity and mortality. Surgery is the primary therapy for all causes of CS, but surgical failure and ineligibility of the patient to undergo surgery necessitate alternative treatment modalities. The role of medical therapy in CS has been limited because of lack of efficacy or intolerability. In recent years, however, new targets for medical therapy have been identified, both at the level of the pituitary gland (e.g. somatostatin, dopamine, and epidermal growth factor receptors) and the adrenal gland (ectopically expressed receptors in ACTH-independent macronodular adrenal hyperplasia). In this review, results of preclinical and clinical studies with drugs that exert their action through these molecular targets, as well as already established medical treatment options, will be discussed.

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The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Cited by 79 publications

References 59 publications

MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

Radiotherapy and radiosurgery for Cushing's disease

New developments in the medical treatment of Cushing's syndrome

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