Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, Preston Research Building, Rm B-1003, Nashville, TN, 37232-5671, USA.
Pituitary. 2019 Dec;22(6):607-613. doi: 10.1007/s11102-019-00992-6.
Hypofractionated stereotactic radiotherapy (HSRT) for refractory Cushing's disease may offer a condensed treatment schedule for patients with large tumors abutting the optic chiasm unsuitable for stereotactic radiosurgery (SRS). To-date only four patients have been treated by HSRT in the published literature. We investigated the feasibility, toxicity, and efficacy of HSRT compared to SRS.
After approval, we retrospectively evaluated patients treated at our institution for refractory Cushing's disease with SRS or HSRT. Study outcomes included biochemical control, time to biochemical control, local control, and late complications. Binary logistic regression and Cox proportional hazards regression evaluated predictors of outcomes.
Patients treated with SRS (n = 9) and HSRT (n = 9) were enrolled with median follow-up of 3.4 years. Clinicopathologic details were balanced between the cohorts. Local control was 100% in both cohorts. Time to biochemical control was 6.6. and 9.5 months in the SRS and HSRT cohorts, respectively (p = 0.6258). Two patients in each cohort required salvage bilateral adrenalectomy. Late complications including secondary malignancy, radionecrosis, cranial nerve neuropathy, and optic pathway injury were minimal for either cohort.
HSRT is an appropriate treatment approach for refractory Cushing's disease, particularly for patients with large tumors abutting the optic apparatus. Prospective studies are needed to validate these findings and identify factors suggesting optimal fractionation approaches.
对于毗邻视交叉的大型肿瘤不适合立体定向放射手术（SRS）的难治性库欣病患者，分次立体定向放射治疗（HSRT）可能提供一种更集中的治疗方案。迄今为止，只有四项在已发表的文献中对难治性库欣病患者进行了 HSRT 治疗。我们研究了 HSRT 与 SRS 相比的可行性、毒性和疗效。
在获得批准后，我们回顾性地评估了在我们机构接受 SRS 或 HSRT 治疗的难治性库欣病患者。研究结果包括生化控制、达到生化控制的时间、局部控制和晚期并发症。二元逻辑回归和 Cox 比例风险回归分析了预测结果的因素。
接受 SRS（n=9）和 HSRT（n=9）治疗的患者分别纳入队列，中位随访时间为 3.4 年。两组的临床病理特征平衡。两组的局部控制率均为 100%。SRS 和 HSRT 组的生化控制时间分别为 6.6 和 9.5 个月（p=0.6258）。两组各有 2 例患者需要进行双侧肾上腺切除术作为挽救治疗。晚期并发症包括继发性恶性肿瘤、放射性坏死、颅神经神经病和视路损伤，两组均很少见。
HSRT 是治疗难治性库欣病的一种合适方法，特别是对于毗邻视器的大型肿瘤患者。需要前瞻性研究来验证这些发现，并确定提示最佳分割方法的因素。
