Intensity-modulated radiotherapy for cushing’s disease: single-center experience in 70 patients

Frontiers in Endocrinology

Endocrinology

Huijuan Zhu¹  Lin Lu¹  Zhuoran Xu¹  Weiping Wang²  Fuquan Zhang²  Shuai Sun²  Xin Lian²  Xiaorong Hou² 

[1] Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China;Department of Radiation Oncology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China;

关键词: cushing’s disease;    intensity-modulated radiotherapy;    radiotherapy;    pituitary adenoma;    ACTH;   

DOI  :  10.3389/fendo.2023.1241669

 received in 2023-06-17, accepted in 2023-08-31,  发布年份 2023

来源: Frontiers

【 摘 要 】

ContextIntensity-modulated radiotherapy (IMRT) is a modern precision radiotherapy technique for the treatment of the pituitary adenoma.ObjectiveAim to investigate the efficacy and toxicity of IMRT in treating Cushing’s Disease (CD).Methods70 of 115 patients with CD treated with IMRT at our institute from April 2012 to August 2021 were included in the study. The radiation doses were usually 45-50 Gy in 25 fractions. After IMRT, endocrine evaluations were performed every 6 months and magnetic resonance imaging (MRI) annually. Endocrine remission was defined as suppression of 1 mg dexamethasone test (DST) or normal 24-hour urinary free cortisol level (24hUFC). The outcome of endocrine remission, endocrine recurrence, tumor control and complications were retrieved from medical record.ResultsAt a median follow-up time of 36.8 months, the endocrine remission rate at 1, 2, 3 and 5 years were 28.5%, 50.2%, 62.5% and 74.0%, respectively. The median time to remission was 24 months (95%CI: 14.0-34.0). Endocrine recurrence was found in 5 patients (13.5%) till the last follow-up. The recurrence-free rate at 1, 2, 3 and 5 years after endocrine remission was 98.2%, 93.9%, 88.7% and 88.7%, respectively. The tumor control rate was 98%. The overall incidence of new onset hypopituitarism was 22.9%, with hypothyroidism serving as the most common individual axis deficiency. Univariate analysis indicated that only higher Ki-67 index (P=0.044) was significant favorable factors for endocrine remission.ConclusionIMRT was a highly effective second-line therapy with low side effect profile for CD patients. Endocrine remission, tumor control and recurrence rates were comparable to previous reports on FRT and SRS.

【 授权许可】

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Copyright © 2023 Lian, Xu, Sun, Wang, Zhu, Lu, Hou and Zhang