Cushing's disease: a single centre's experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy.
Cushing's disease is hypercortisolaemia secondary to an adrenocorticotrophic hormone secreting pituitary adenoma. Primary management is almost always surgical, with limited effective medical interventions available. Adjuvant therapy in the form of radiation is gaining popularity, with the bulk of the literature related to the Gamma Knife. We present the results from our own institution using the linear accelerator (LINAC) since 1990. Thirty-six patients who underwent stereotactic radiosurgery (SRS), one patient who underwent fractionated stereotactic radiotherapy (FSRT) and for the purposes of comparison, 13 patients who had undergone conventional radiotherapy prior to 1990, were included in the analysis. Serum cortisol levels improved in nine of 36 (25%) SRS patients and 24 hour urinary free cortisol levels improved in 13 of 36 patients (36.1%). Tumour volume control was excellent in the SRS group with deterioration in only one patient (3%). The patient who underwent FSRT had a highly aggressive tumour refractory to radiation.
Department of Radiation Oncology, The Prince of Wales Cancer Centre, Level 2, High Street, Randwick, NSW 2031, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
P J
PJ
Wilson
Department of Radiation Oncology, The Prince of Wales Cancer Centre, Level 2, High Street, Randwick, NSW 2031, Australia. Electronic address: Janet.Williams2@sesiahs.health.nsw.gov.au.
J R
JR
Williams
Department of Radiation Oncology, The Prince of Wales Cancer Centre, Level 2, High Street, Randwick, NSW 2031, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
R I
RI
Smee
D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010315:Particle Accelerators; D047748:Pituitary ACTH Hypersecretion / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Cushing’s disease; Endocrine therapy; Fractionated radiotherapy; Linear accelerator; Post treatment complications; Stereotactic radiosurgery; Tumour control