Document Detail


Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease.
MedLine Citation:
PMID:  17218730     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. DESIGN: 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). CONCLUSION: 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.
Authors:
F Castinetti; M Nagai; H Dufour; J-M Kuhn; I Morange; P Jaquet; B Conte-Devolx; J Regis; T Brue
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  156     ISSN:  0804-4643     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-12     Completed Date:  2007-03-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  91-8     Citation Subset:  IM    
Affiliation:
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.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenocorticotropic Hormone / blood
Adult
Aged
Child, Preschool
Dexamethasone / diagnostic use
Diagnostic Imaging
Estradiol / blood
Female
Follow-Up Studies
Humans
Hydrocortisone / blood,  urine
Male
Middle Aged
Neurosurgical Procedures
Pituitary ACTH Hypersecretion / surgery*
Radiosurgery* / adverse effects
Testosterone / blood
Treatment Outcome
Chemical
Reg. No./Substance:
50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 50-28-2/Estradiol; 58-22-0/Testosterone; 9002-60-2/Adrenocorticotropic Hormone

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