Pituitary radiotherapy for Cushing's disease

Marco Losa, Piero Picozzi, Maria Grazia Redaelli, Andrea Laurenzi, Pietro Mortini

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: The treatment of choice for Cushing's disease is pituitary surgery. Second-line treatments include repeat pituitary surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. The most used modalities to irradiate patients with Cushing's disease include fractionated radiotherapy and single-dose Gamma Knife. We aim to review the efficacy and safety of radiotherapy in patients with persistent or recurring Cushing's disease. Results: Remission of Cushing's disease after radiotherapy ranges from 42 to 83%. There seems to be no clear difference according to the technique of radiation used. Most patients experience remission of disease within 3 years from treatment, with only few cases reaching normal cortisol secretion after a longer follow-up. Control of tumor growth varies from 93 to 100%. Severe side effects of radiotherapy, such as optic neuropathy and radionecrosis, are uncommon. New-onset hypopituitarism is the most frequent side effect of radiation, occurring in 30-50% of patients treated by fractionated radiotherapy while it has been reported in 11-22% of patients after Gamma Knife. Conclusion: Radiotherapy is an effective second-line treatment in patients with Cushing's disease not cured by surgery. Consideration of the advantages and disadvantages of radiotherapy in comparison with other therapeutic options should always be carried out in the single patient before deciding the second-line therapeutic strategy for persisting or recurring Cushing's disease.

Original languageEnglish
Pages (from-to)107-110
Number of pages4
JournalNeuroendocrinology
Volume92
Issue numberSUPPL. 1
DOIs
Publication statusPublished - Sep 2010

Fingerprint

Pituitary ACTH Hypersecretion
Radiotherapy
Therapeutics
Hypopituitarism
Optic Nerve Diseases
Adrenalectomy
Radiation Effects
Reoperation
Hydrocortisone
Radiation
Safety
Growth

Keywords

  • Adrenocorticotropin
  • Cortisol
  • Pituitary neoplasm
  • Pituitary surgery
  • Radiosurgery
  • Radiotherapy

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Endocrine and Autonomic Systems
  • Cellular and Molecular Neuroscience

Cite this

Pituitary radiotherapy for Cushing's disease. / Losa, Marco; Picozzi, Piero; Redaelli, Maria Grazia; Laurenzi, Andrea; Mortini, Pietro.

In: Neuroendocrinology, Vol. 92, No. SUPPL. 1, 09.2010, p. 107-110.

Research output: Contribution to journalArticle

Losa, Marco ; Picozzi, Piero ; Redaelli, Maria Grazia ; Laurenzi, Andrea ; Mortini, Pietro. / Pituitary radiotherapy for Cushing's disease. In: Neuroendocrinology. 2010 ; Vol. 92, No. SUPPL. 1. pp. 107-110.
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abstract = "Background: The treatment of choice for Cushing's disease is pituitary surgery. Second-line treatments include repeat pituitary surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. The most used modalities to irradiate patients with Cushing's disease include fractionated radiotherapy and single-dose Gamma Knife. We aim to review the efficacy and safety of radiotherapy in patients with persistent or recurring Cushing's disease. Results: Remission of Cushing's disease after radiotherapy ranges from 42 to 83{\%}. There seems to be no clear difference according to the technique of radiation used. Most patients experience remission of disease within 3 years from treatment, with only few cases reaching normal cortisol secretion after a longer follow-up. Control of tumor growth varies from 93 to 100{\%}. Severe side effects of radiotherapy, such as optic neuropathy and radionecrosis, are uncommon. New-onset hypopituitarism is the most frequent side effect of radiation, occurring in 30-50{\%} of patients treated by fractionated radiotherapy while it has been reported in 11-22{\%} of patients after Gamma Knife. Conclusion: Radiotherapy is an effective second-line treatment in patients with Cushing's disease not cured by surgery. Consideration of the advantages and disadvantages of radiotherapy in comparison with other therapeutic options should always be carried out in the single patient before deciding the second-line therapeutic strategy for persisting or recurring Cushing's disease.",
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