Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease.
OBJECTIVE
Though transsphenoidal surgery remains the first-line treatment of Cushing's disease, recurrence occurs frequently. Conventional radiotherapy and anticortisolic drugs both have adverse effects. Stereotactic radiosurgery needs to be evaluated more precisely. The aim of this study was to determine long-term hormonal effects and tolerance of gamma knife (GK) radiosurgery in Cushing's disease.


METHODS
Forty patients with Cushing's disease treated by GK were prospectively studied over a decade, with a mean follow-up of 54.7 months. Eleven of them were treated with GK as a primary treatment.


METHODS
Radiosurgery was performed at the Department of Functional Neurosurgery of Marseille, France, using the Leksell Gamma Unit B and C models. Median margin dose was 29.5 Gy. Patients were considered in remission if they had normalized 24-h free urinary cortisol and suppression of plasma cortisol after low-dose dexamethasone suppression test.


RESULTS
Seventeen patients (42.5%) were in remission after a mean of 22 months (range 12-48 months). The two groups did not differ in terms of initial hormonal levels. Target volume was significantly higher in uncured than in remission group (909.8 vs 443 mm(3), P = 0.038). We found a significant difference between patients who were on or off anticortisolic drugs at the time of GK (20 vs 48% patients in remission respectively, P = 0.02).


CONCLUSIONS
With 42% of patients in remission after a median follow-up of 54 months, GK stereotactic radiosurgery, especially as an adjunctive treatment to surgery, may represent an alternative to other therapeutic options in view of their adverse effects.
Castinetti
F
F
Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, 264 rue St Pierre, cedex 5, 13385 Marseille, France.
Nagai
M
M
Dufour
H
H
Kuhn
J-M
JM
Morange
I
I
Jaquet
P
P
Conte-Devolx
B
B
Regis
J
J
Brue
T
T
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D003907:Dexamethasone; D003952:Diagnostic Imaging; D004958:Estradiol / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D013739:Testosterone; D004958:Estradiol; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone