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Exp Clin Endocrinol Diabetes 2021; 129(07): 482-491
DOI: 10.1055/a-1217-7365
Article

Efficacy and Safety of Stereotactic Radiotherapy in Cushing’s Disease: A Single Center Experience

Tugce Apaydin 
1   Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Hande Mefkure Ozkaya
2   Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Sebnem Memis Durmaz
3   Department of Radiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Rasim Meral
4   Deparment of Radiation Oncology, Istanbul Medical School, Institute of Oncology, Istanbul University, Istanbul, Turkey
,
Pinar Kadioglu
2   Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
5   Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
› Author Affiliations Funding: This study did not receive any specific grants from any funding agencies in the public, commercial, or not-for-profit sector.
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Abstract

Objective To determine the efficacy and safety of stereotactic radiotherapy (RT) in patients with Cushing’s disease (CD).

Methods The study included 38 patients [31 patients who received gamma knife radiosurgery (GKS) and 7 patients who received cyberknife hypofractionated RT (HFRT)] with CD. Hormonal remission was considered if the patient had suppressed cortisol levels after low dose dexamethasone, normal 24-hour urinary free cortisol (UFC), and lack or regression of clinical features.

Results Biochemical control after RT was observed in 52.6% of the patients with CD and median time to hormonal remission was 15 months. Tumor size control was obtained in all of the patients. There was no significant relationship between remission rate and laboratory, radiological and pathological variables except for preoperative UFC. Remission rate was higher in patients with lower preoperative UFC. Time to remission increased in parallel to postoperative cortisol and 1mg DST level. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to hormonal remission.

Conclusion In this current single center experience, postoperative cortisol and 1mg DST levels were found as the determinants of time to remission. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to biochemical control . This latter finding might suggest a radioprotective effect of cortisol lowering medication use on peri-RT period.

Key words

Cushing’s disease - cyberknife hypofractionated radiotherapy - gamma knife radiosurgery - stereotactic


Publication History

Received: 11 May 2020
Received: 18 June 2020

Accepted: 08 July 2020

Article published online:
06 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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