Journal of Neurosurgical Sciences 2020 Sep 28

DOI: 10.23736/S0390-5616.20.05048-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Efficacy of whole-sellar Gamma Knife Radiosurgery for magnetic resonance imaging-negative Cushing’s disease

Nulifer KILIC DURANKUS ¹, Yavuz SAMANCI ², Meltem YILMAZ ³, Meriç SENGOZ ⁴, Yasemin BOLUKBASI ⁵, Selcuk PEKER ⁶ ✉

¹ Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey; ² Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey; ³ Medical Biotechnology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey; ⁴ Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey; ⁵ Department of Radiation Oncology, School of Medicine, Koç University, Istanbul, Turkey; ⁶ Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey

BACKGROUND: Corticotroph adenoma delineation in Cushing’s disease (CD) patients with previous surgery can be challenging. This study investigated the outcome of wholesellar Gamma Knife Radiosurgery (GKRS) in MRI-negative, but hormone-active CD patients with prior failed treatment attempts.
METHODS: We retrospectively analyzed data of nine CD cases who underwent wholesellar GKRS between April 2008 and April 2020 at a single center. Remission was determined as normal morning serum cortisol, normal 24-hour urinary free cortisol (UFC), or extended postoperative requirement for hydrocortisone replacement.
RESULTS: Median age was 35.0 years, and most of the cases were female (89%). All subjects had undergone previous surgery. The mean pre-GKRS morning serum cortisol and 24-hour UFC was 27.5 mcg/dL and 408.0 mcg, respectively. Target volume varied from 0.6 to 1.8 cc, and the median margin dose was 28 Gy. The median duration of endocrine follow-up was 105 months, and initial endocrine remission was achieved in eight subjects (89%) at a median time of 22 months. The actuarial initial remission was 44% at two years, 67% at four years, and 89% at six years. The mean recurrence-free survival was 128 months. Age and pre-GKRS morning serum cortisol were found to be predictors for initial and durable endocrine remissions. New-onset hypopituitarism was observed in two of five patients (40%). None of the patients developed new neurological deficits and had GKRS-related adverse events during the follow-up.
CONCLUSIONS: Whole-sellar GKRS is a safe and efficient method to manage MRInegative CD and provides similar GKRS outcome rates as in MRI-positive CD.

KEY WORDS: Cortisol; Cushing disease; Gamma Knife Radiosurgery; Remission; Wholesellar