Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing's Disease: Results from a Multicenter, International Cohort Study

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11120%2F18%3A43916706" target="_blank" >RIV/00216208:11120/18:43916706 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00064173:_____/18:N0000030

Výsledek na webu

<a href="https://doi.org/10.1016/j.wneu.2018.05.067" target="_blank" >https://doi.org/10.1016/j.wneu.2018.05.067</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.wneu.2018.05.067" target="_blank" >10.1016/j.wneu.2018.05.067</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing's Disease: Results from a Multicenter, International Cohort Study

Popis výsledku v původním jazyce

BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing&apos;s disease (CD) who have failed surgical/medical management. As many patients with recurrent/persistent CD lack an identifiable adenoma on neuro-imaging, whole-sellar SRS has been increasingly employed. We therefore sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort-design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS versus patients who underwent discreet-adenoma-targeted SRS. RESULTS: 68 patients underwent whole-sellar SRS with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6cm 3 and the mean margin dose was 22.4Gy. The 5-year actuarial remission rate was 75.9%. The median time to remission was 12-months. Treatment volumes greater than 1.6cm 3 were associated with shorter times to remission (p&lt;0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (p&lt;0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS versus discreet adenoma-targeted SRS. CONCLUSIONS: Whole-sellar GKRS is effective at controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who receive whole-sellar SRS have outcomes and rates of new pituitary-hormone deficiency similar to patients who undergo discrete-adenoma-targeted GKRS.

Název v anglickém jazyce

Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing's Disease: Results from a Multicenter, International Cohort Study

Popis výsledku anglicky

BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing&apos;s disease (CD) who have failed surgical/medical management. As many patients with recurrent/persistent CD lack an identifiable adenoma on neuro-imaging, whole-sellar SRS has been increasingly employed. We therefore sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort-design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS versus patients who underwent discreet-adenoma-targeted SRS. RESULTS: 68 patients underwent whole-sellar SRS with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6cm 3 and the mean margin dose was 22.4Gy. The 5-year actuarial remission rate was 75.9%. The median time to remission was 12-months. Treatment volumes greater than 1.6cm 3 were associated with shorter times to remission (p&lt;0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (p&lt;0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS versus discreet adenoma-targeted SRS. CONCLUSIONS: Whole-sellar GKRS is effective at controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who receive whole-sellar SRS have outcomes and rates of new pituitary-hormone deficiency similar to patients who undergo discrete-adenoma-targeted GKRS.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30212 - Surgery

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2018

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

World Neurosurgery

ISSN

1878-8750

e-ISSN

—

Svazek periodika

116

Číslo periodika v rámci svazku

August

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

10

Strana od-do

"e670"-"e679"

Kód UT WoS článku

000439498500086

EID výsledku v databázi Scopus

2-s2.0-85048016149