Minniti Giuseppe, Brada Michael
Department of Neurological Sciences, Neuroendocrinology Unit, NEUROMED Institute, Pozzilli, IS, Italy.
Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1373-80. doi: 10.1590/s0004-27302007000800024.
Patients with residual or recurrent Cushing's disease receive external beam radiotherapy (RT) with the aim of achieving long-term tumour control and normalization of elevated hormone levels. Treatment is given either as conventional radiotherapy using conformal techniques or as stereotactic radiotherapy, which is either used as fractionated treatment (SCRT) or as single fraction radiosurgery (SRS). We describe the technical aspects of treatment and report a systematic review of the published literature on the efficacy and toxicity of conventional RT, SCRT and SRS. There are no studies directly comparing the different radiation techniques and the reported results are inevitably of selected patients by investigators with interest in the treatment tested. Nevertheless the review of the published literature suggests better hormone and tumour control rates after fractionated irradiation compared to single fraction radiosurgery. Hypopituitarism represents the most commonly reported late complication of radiotherapy seen after all treatments. Although the incidence of other late effects is low, the risk of radiation injury to normal neural structures is higher with single fraction compared to fractionated treatment. Stereotactic techniques offer more localized irradiation compared with conventional radiotherapy, however longer follow-up is necessary to confirm the potential reduction of long-term radiation toxicity of fractionated SCRT compared to conventional RT. On the basis of the available literature, fractionated conventional and stereotactic radiotherapy offer effective treatment for Cushing's disease not controlled with surgery alone. The lower efficacy and higher toxicity of single fraction treatment suggest that SRS is not the appropriate therapy for the majority of patients with Cushing's disease.
残留或复发性库欣病患者接受外照射放疗（RT），目的是实现长期肿瘤控制以及使升高的激素水平恢复正常。治疗可采用使用适形技术的传统放疗，也可采用立体定向放疗，立体定向放疗可作为分次治疗（SCRT）或单次分割放射外科手术（SRS）。我们描述了治疗的技术方面，并报告了关于传统放疗、SCRT和SRS的疗效及毒性的已发表文献的系统综述。尚无直接比较不同放疗技术的研究，且所报告的结果不可避免地是由对所测试治疗感兴趣的研究者选择的患者的结果。然而，对已发表文献的综述表明，与单次分割放射外科手术相比，分次照射后激素和肿瘤控制率更高。垂体功能减退是所有治疗后放疗最常见的晚期并发症。尽管其他晚期效应的发生率较低，但与分次治疗相比，单次分割时正常神经结构受辐射损伤的风险更高。与传统放疗相比，立体定向技术提供更局部的照射，然而，与传统放疗相比，需要更长时间的随访来证实分次SCRT长期辐射毒性的潜在降低。根据现有文献，分次传统放疗和立体定向放疗为单独手术无法控制的库欣病提供了有效的治疗方法。单次分割治疗较低的疗效和较高的毒性表明，SRS不适用于大多数库欣病患者。
