Skip to main content
SpringerLink
Log in

Radiation Therapy in the Management of Cushing’s Disease

  • Chapter
  • First Online:
Cushing's Disease

Part of the book series: Endocrine Updates ((ENDO,volume 31))

  • 1479 Accesses

Abstract

Radiation therapy is most commonly offered to patients with Cushing’s disease who are incompletely treated after transsphenoidal surgery because of residual or recurrent disease. Retrospective data suggest that both fractionated External Beam Radiation Therapy (EBRT) and single-fraction Stereotactic Radiosurgery (SRS) offer biochemical remission rates of 50–80%. SRS appears to normalize hormonal levels more rapidly than fractionated EBRT and should be offered when technically feasible. Hypopituitarism is common and expected after pituitary irradiation. Other late side effects are uncommon.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bochicchio D, Losa M, Buchfelder M. Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing’s Disease Survey Group. J Clin Endocrinol Metab. 1995;80:3114–20.

    Article  PubMed  CAS  Google Scholar 

  2. Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Endocrinol Metab. 1999;84:440–8.

    Article  PubMed  CAS  Google Scholar 

  3. Knappe UJ, Ludecke DK. Persistent and recurrent hypercortisolism after transsphenoidal surgery for Cushing’s disease. Acta Neurochir Suppl. 1996;65:31–4.

    PubMed  CAS  Google Scholar 

  4. Hallberg F. Pituitary tumors. In: Liebel S, editor. Textbook of radiation oncology. Philadelphia: WB Saunders; 1998. p. 357.

    Google Scholar 

  5. Suh JH, Saxton JP. Conventional radiation therapy for skull base tumors: an overview. Neurosurg Clin N Am. 2000;11:575–86.

    PubMed  CAS  Google Scholar 

  6. Kooy HM, Nedzi LA, Loeffler JS, et al. Treatment planning for stereotactic radiosurgery of intra-cranial lesions. Int J Radiat Oncol Biol Phys. 1991;21:683–93.

    Article  PubMed  CAS  Google Scholar 

  7. Landolt AM, Haller D, Lomax N, et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg. 1998;88:1002–8.

    Article  PubMed  CAS  Google Scholar 

  8. Sheehan JP, Niranjan A, Sheehan JM, et al. Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg. 2005;102:678–91.

    Article  PubMed  Google Scholar 

  9. Tishler RB, Loeffler JS, Lunsford LD, et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys. 1993;27:215–21.

    PubMed  CAS  Google Scholar 

  10. Sandler LM, Richards NT, Carr DH, Mashiter K, Joplin GF. Long term follow-up of patients with Cushing’s disease treated by interstitial irradiation. J Clin Endocrinol Metab. 1987;65:441–7.

    Article  PubMed  CAS  Google Scholar 

  11. Cassar J, Doyle FH, Mashiter K, Joplin GF. Treatment of Cushing’s disease in juveniles with interstitial pituitary irradiation. Clin Endocrinol (Oxf). 1979;11:313–21.

    Article  CAS  Google Scholar 

  12. Molinatti GM, Limone P, Porta M. Treatment of Cushing’s disease by interstitial pituitary irradiation: short- and long-term follow-up. Panminerva Med. 1995;37:1–7.

    PubMed  CAS  Google Scholar 

  13. Zierhut D, Flentje M, Adolph J, Erdmann J, Raue F, Wannenmacher M. External radiotherapy of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1995;33:307–14.

    Article  PubMed  CAS  Google Scholar 

  14. Aristizabal S, Caldwell WL, Avila J. The relationship of time-dose fractionation factors to complications in the treatment of pituitary tumors by irradiation. Int J Radiat Oncol Biol Phys. 1977;2:667–73.

    Article  PubMed  CAS  Google Scholar 

  15. Murayama M, Yasuda K, Minamori Y, Mercado-Asis LB, Yamakita N, Miura K. Long term follow-up of Cushing’s disease treated with reserpine and pituitary irradiation. J Clin Endocrinol Metab. 1992;75:935–42.

    Article  PubMed  CAS  Google Scholar 

  16. Ahmed SR, Shalet SM, Beardwell CG, Sutton ML. Treatment of Cushing’s disease with low dose radiation therapy. Br Med J (Clin Res Ed). 1984;289:643–6.

    Article  CAS  Google Scholar 

  17. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Sutton ML. Long-term follow-up of low-dose external pituitary irradiation for Cushing’s disease. Clin Endocrinol (Oxf). 1990;33:445–55.

    Article  CAS  Google Scholar 

  18. Marks LB. Conventional fractionated radiation therapy vs. radiosurgery for selected benign intracranial lesions (arteriovenous malformations, pituitary adenomas, and acoustic neuromas). J Neurooncol. 1993;17:223–30.

    Article  PubMed  CAS  Google Scholar 

  19. Estrada J, Boronat M, Mielgo M, et al. The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med. 1997;336:172–7.

    Article  PubMed  CAS  Google Scholar 

  20. Howlett TA, Plowman PN, Wass JA, Rees LH, Jones AE, Besser GM. Megavoltage pituitary irradiation in the management of Cushing’s disease and Nelson’s syndrome: long-term follow-up. Clin Endocrinol (Oxf). 1989;31:309–23.

    Article  CAS  Google Scholar 

  21. Hughes MN, Llamas KJ, Yelland ME, Tripcony LB. Pituitary adenomas: long-term results for radiotherapy alone and post-operative radiotherapy. Int J Radiat Oncol Biol Phys. 1993;27:1035–43.

    Article  PubMed  CAS  Google Scholar 

  22. Jennings AS, Liddle GW, Orth DN. Results of treating childhood Cushing’s disease with pituitary irradiation. N Engl J Med. 1977;297:957–62.

    Article  PubMed  CAS  Google Scholar 

  23. Ross WM, Evered DC, Hunter P, Benaim M, Cook D, Hall R. Treatment of Cushing’s disease with adrenal blocking drugs and megavoltage therapy to the pituitary. Clin Radiol. 1979;30:149–53.

    Article  PubMed  CAS  Google Scholar 

  24. Becker G, Kocher M, Kortmann RD, et al. Radiation therapy in the multimodal treatment approach of pituitary adenoma. Strahlenther Onkol. 2002;178:173–86.

    Article  PubMed  Google Scholar 

  25. Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws Jr ER. Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg. 2000;93:738–42.

    Article  PubMed  CAS  Google Scholar 

  26. Devin JK, Allen GS, Cmelak AJ, Duggan DM, Blevins LS. The efficacy of linear accelerator radiosurgery in the management of patients with Cushing’s disease. Stereotact Funct Neurosurg. 2004;82:254–62.

    Article  PubMed  Google Scholar 

  27. Mitsumori M, Shrieve DC, Alexander 3rd E, et al. Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys. 1998;42:573–80.

    Article  PubMed  CAS  Google Scholar 

  28. Yoon SC, Suh TS, Jang HS, et al. Clinical results of 24 pituitary macroadenomas with linac-based stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 1998;41:849–53.

    Article  PubMed  CAS  Google Scholar 

  29. Levy RP, Fabrikant JI, Frankel KA, et al. Heavy-charged-particle radiosurgery of the pituitary gland: clinical results of 840 patients. Stereotact Funct Neurosurg. 1991;57:22–35.

    Article  PubMed  CAS  Google Scholar 

  30. Ronson BB, Schulte RW, Han KP, Loredo LN, Slater JM, Slater JD. Fractionated proton beam irradiation of pituitary adenomas. Int J Radiat Oncol Biol Phys. 2006;64:425–34.

    Article  PubMed  Google Scholar 

  31. Petit JH, Biller BM, Yock TI, et al. Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas. J Clin Endocrinol Metab. 2008;93:393–9.

    Article  PubMed  CAS  Google Scholar 

  32. Minniti G, Osti M, Jaffrain-Rea ML, Esposito V, Cantore G, Maurizi Enrici R. Long-term follow-up results of postoperative radiation therapy for Cushing’s disease. J Neurooncol. 2007;84:79–84.

    Article  PubMed  Google Scholar 

  33. Hoybye C, Grenback E, Rahn T, Degerblad M, Thoren M, Hulting AL. Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery. Neurosurgery. 2001;49:284–91. discussion 91–2.

    Article  PubMed  CAS  Google Scholar 

  34. Vladyka V, Liscak R, Novotny Jr J, Marek J, Jezkova J. Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery. 2003;52:309–16. discussion 16–7.

    Article  PubMed  Google Scholar 

  35. Feigl GC, Bonelli CM, Berghold A, Mokry M. Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg. 2002;97:415–21.

    PubMed  Google Scholar 

  36. Pai HH, Thornton A, Katznelson L, et al. Hypothalamic/pituitary function following high-dose conformal radiotherapy to the base of skull: demonstration of a dose-effect relationship using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2001;49:1079–92.

    Article  PubMed  CAS  Google Scholar 

  37. Brada M, Rajan B, Traish D, et al. The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf). 1993;38:571–8.

    Article  CAS  Google Scholar 

  38. Tsang RW, Laperriere NJ, Simpson WJ, Brierley J, Panzarella T, Smyth HS. Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk. Cancer. 1993;72:2227–33.

    Article  PubMed  CAS  Google Scholar 

  39. Brada M, Burchell L, Ashley S, Traish D. The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys. 1999;45:693–8.

    Article  PubMed  CAS  Google Scholar 

  40. Schteingart DE, Tsao HS, Taylor CI, McKenzie A, Victoria R, Therrien BA. Sustained remission of Cushing’s disease with mitotane and pituitary irradiation. Ann Intern Med. 1980;92:613–9.

    PubMed  CAS  Google Scholar 

  41. Tsang RW, Brierley JD, Panzarella T, Gospodarowicz MK, Sutcliffe SB, Simpson WJ. Role of radiation therapy in clinical hormonally-active pituitary adenomas. Radiother Oncol. 1996;41:45–53.

    Article  PubMed  CAS  Google Scholar 

  42. Laws Jr ER, Vance ML. Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am. 1999;10:327–36.

    PubMed  Google Scholar 

  43. Kobayashi T, Kida Y, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg. 2002;97:422–8.

    PubMed  Google Scholar 

  44. Castinetti F, Nagai M, Dufour H, et al. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease. Eur J Endocrinol. 2007;156:91–8.

    Article  PubMed  CAS  Google Scholar 

  45. Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma knife surgery for Cushing’s disease. J Neurosurg. 2007;106:980–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Cox 3, Boston, MA, 02114, USA

    Kevin S. Oh

  2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Helen A. Shih & Jay S. Loeffler

Authors
  1. Kevin S. Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen A. Shih
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jay S. Loeffler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin S. Oh .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Dept. Neurosurgery, Harvard Medical School, Parkman St. 15, Boston, 02114, Massachusetts, USA

    Brooke Swearingen

  2. Neuroendocrine Clinical Centre, Massachusetts General Hospital, Fruit St. 55, Boston, 02114, Massachusetts, USA

    Beverly M. K. Biller

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Oh, K.S., Shih, H.A., Loeffler, J.S. (2011). Radiation Therapy in the Management of Cushing’s Disease. In: Swearingen, B., Biller, B. (eds) Cushing's Disease. Endocrine Updates, vol 31. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0011-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0011-0_11

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-0010-3

  • Online ISBN: 978-1-4614-0011-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation