Radiotherapy and radiosurgery for Cushing's disease

Giuseppe Minniti, Michael Brada

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease.

Original languageEnglish
Pages (from-to)1373-1380
Number of pages8
JournalArquivos Brasileiros de Endocrinologia e Metabologia
Volume51
Issue number8
Publication statusPublished - Nov 2007

Keywords

  • Cushing's disease
  • Fractionated stereotactic radiotherapy
  • Pituitary adenomas
  • Radiosurgery
  • Toxicity

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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