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Long-term follow-up results of postoperative radiation therapy for Cushing’s disease

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Abstract

Objectives

Radiotherapy is currently used in patients with residual or recurrent pituitary adenomas after surgery. However, there is little information of long-term outcome of patients with Cushing’s disease following radiotherapy. We assessed the long-term efficacy and toxicity of conventional radiotherapy in the control of Cushing’s disease after unsuccessful transsphenoidal surgery.

Patients and Methods

Forty patients with Cushing’s disease were treated with conventional external beam radiotherapy at our Institution between 1988 and 2002. The median age was 38. All patients received radiotherapy following unsuccessful surgery or at tumour recurrence to a dose of 45–50 Gy in 25–28 fractions. The persistence of active disease after surgery was diagnosed by the increased high plasma cortisol levels, high 24 h urinary cortisol levels and absence of cortisol suppression after administration of dexamethasone.

Results

The 5 and 10 year local tumour control was 93% and the 5 and 10 year survival was 97 and 95%. Normalization of plasma cortisol was seen in 28% of patients at 1 year, 73% at 3 years, 78% at 5 years and 84% at 10 years. The average timing to remission was 24 months. The most common side effect was hypopituitarism that increased progressively during the follow-up, being present in 62% and in 76% of patients at 5 and 10 years after RT. There were no other serious complications as radiation induced optic neuropathy or second tumours.

Conclusion

Radiotherapy is effective in the long-term tumour- and hormone hypersecretion control of ACTH-secreting pituitary adenomas, however with a high prevalence of hypopituitarism. At the moment, it remains an important treatment option after failure of surgery.

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Acknowledgements

This study was supported by the Radiotherapy Oncology Research Fund of University of Rome “La Sapienza”.

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Authors and Affiliations

  1. Department of Radiotherapy Oncology, Sant’Andrea Hospital, University of Rome “La Sapienza”, Via di Grottarossa 1035à, 00189, Rome, Italy

    Giuseppe Minniti, Mattia Osti & Riccardo Maurizi Enrici

  2. Department of Neurological Sciences, NEUROMED Institute, University of Rome “La Sapienza”, Pozzilli, IS, Italy

    Giuseppe Minniti, Marie Lise Jaffrain-Rea, Vincenzo Esposito & Giampaolo Cantore

  3. Department of Experimental Medicine, University of L’Aquila, Aquila, Italy

    Marie Lise Jaffrain-Rea

Authors
  1. Giuseppe Minniti
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  2. Mattia Osti
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  3. Marie Lise Jaffrain-Rea
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  4. Vincenzo Esposito
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  5. Giampaolo Cantore
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  6. Riccardo Maurizi Enrici
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Correspondence to Giuseppe Minniti.

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Minniti, G., Osti, M., Jaffrain-Rea, M.L. et al. Long-term follow-up results of postoperative radiation therapy for Cushing’s disease. J Neurooncol 84, 79–84 (2007). https://doi.org/10.1007/s11060-007-9344-0

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  • DOI: https://doi.org/10.1007/s11060-007-9344-0

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