HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Castinetti, F Articles by Brue, T Search for Related Content PubMed Articles by Castinetti, F Articles by Brue, T

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, ¹ Department of Neurosurgery and Functional Neurosurgery, ² Department of Neurosurgery, 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 and ³ Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Universitaire de Rouen, 76031 Rouen, France

(Correspondence should be addressed to T Brue; Email: thierry.brue{at}mail.ap-hm.fr)

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 mm³, 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.

This article has been cited by other articles:

				B. M. K. Biller, A. B. Grossman, P. M. Stewart, S. Melmed, X. Bertagna, J. Bertherat, M. Buchfelder, A. Colao, A. R. Hermus, L. J. Hofland, et al. Treatment of Adrenocorticotropin-Dependent Cushing's Syndrome: A Consensus Statement J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2454 - 2462. [Abstract] [Full Text] [PDF]

				J. H. Petit, B. M. K. Biller, T. I. Yock, B. Swearingen, J. J. Coen, P. Chapman, M. Ancukiewicz, M. Bussiere, A. Klibanski, and J. S. Loeffler Proton Stereotactic Radiotherapy for Persistent Adrenocorticotropin-Producing Adenomas J. Clin. Endocrinol. Metab., February 1, 2008; 93(2): 393 - 399. [Abstract] [Full Text] [PDF]

				F Castinetti, I Morange, P Jaquet, B Conte-Devolx, and T Brue Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease Eur. J. Endocrinol., January 1, 2008; 158(1): 91 - 99. [Abstract] [Full Text] [PDF]