J Neurol Surg B Skull Base 2023; 84(S 01): S1-S344
DOI: 10.1055/s-0043-1762004
Presentation Abstracts
Oral Abstracts

The Superiority of Surgery over Radiotherapy in the Treatment of Recurrent Cushing's Disease: A Systematic Review and Meta-Analysis on Remission and Complications

Mohammadmahdi Sabahi
1   Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Science, Hamadan, Iran
,
Paniz Ghasemi
1   Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Science, Hamadan, Iran
,
Seyed Farzad Maroufi
2   Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
,
Taha Shahbazi
1   Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Science, Hamadan, Iran
,
Omid Yousefi
3   Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Seyed Alireza Shahtaheri
4   Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
,
Karla Arce
5   Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Florida, Weston, Florida, United States
,
Rocco Dabecco
6   Department of Neurological Surgery, Pauline Braathen Neurological Centre, Cleveland Clinic Florida, Weston, Florida, United States
,
Badih Adada
5   Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Florida, Weston, Florida, United States
,
Hamid Borghei-Razavi
5   Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Florida, Weston, Florida, United States
› Author Affiliations
› Further Information
Also available atMedOne
 
 

    Background: Recurrent Cushing's disease (CD) is characterized by the reappearance of clinical and hormonal aspects of hypercortisolism that occur more than 6 months after an initial post-treatment remission.

    Objective: We performed a systematic review and meta-analysis to synthesize the evidence about remission and complication rate after transsphenoidal surgery (TSS) radiotherapy (RT) and medical therapy (MT) in recurrent CD patients.

    Methods: A quantitative systematic review was performed. Article selection was performed by searching MEDLINE (using PubMed), and Cochrane electronic bibliographic databases through August 2021. Random effects model (REM) was applied for meta-analysis. In addition to demographic data, remission rate after different therapeutic modalities as primary outcome measurement, diabetes insipidus (DI), and hypopituitarism (HP), the two most common complications after TSS and/or RT, were assessed as secondary outcomes.

    Results: Among 61 included studies, the type of treatment in recurrent CD patients was TSS in 486 patients, RT in 190 patients, and MT in 26 patients. Using REM, the remission rates were 0.65 [95% confidence interval (CI): 0.60–0.70], 0.57 [95% CI: 0.51–0.63], and 0.75 [95% CI: 0.60–0.86] in the TSS, RT, and MT subgroups, respectively. The total remission rate after therapeutic approaches on recurrent CD patients was 0.64 [95% CI: 0.60–0.68]. A test for subgroup differences revealed there was a statistically significant difference between different subgroups (p = 0.01). The post-hoc test showed that in comparison with RT, TSS (p = 0.0344) and MT (p = 0.0149) had a higher rate of remission. However, there was no statistically significant difference between separate therapeutic modalities in terms of complications including DI (p = 1.0) and HP (p = 0.28).

    Conclusion: Following the second line of CD treatment particularly in recurrent CD patients, a suitable remission rate can be attained with a low rate of complications. Compared with MT and TSS, RT has a statistically lower rate of remission. Although there is robust superiority of surgery over RT, interpretation of MT data must accompany caution due to the small number of included cases and wide CI range.

    Zoom
    PRISMA
    Zoom
    Meta-analysis of remission rate in different therapeutic modalities.
    Zoom
    Meta-analysis of diabetes insipidus (complication).
    Zoom
    Meta-analysis of hypopituitarism (complication).

     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    01 February 2023

    © 2023. Thieme. All rights reserved.

    Georg Thieme Verlag KG
    Rüdigerstraße 14, 70469 Stuttgart, Germany

     
    Zoom
    PRISMA
    Zoom
    Meta-analysis of remission rate in different therapeutic modalities.
    Zoom
    Meta-analysis of diabetes insipidus (complication).
    Zoom
    Meta-analysis of hypopituitarism (complication).