Gao Yuan, Wang Mengqi, Wu Yang, Deng Hao, Xu Yangyang, Ren Yan, Wang Chun, Wang Wei
Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu 610000, China.
Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610000, China.
J Clin Med. 2023 Feb 6;12(4):1288. doi: 10.3390/jcm12041288.
: Gamma knife radiosurgery (GKRS) has served as an adjunctive treatment in Cushing's disease (CD) for decades and has become a vital part of therapy in the management of CD. Biological effective dose (BED) is a radiobiological parameter with time correction, considering the cellular deoxyribonucleic acid repairment. We aimed to investigate the safety and efficacy of GKRS for CD and evaluate the association of BED and treatment outcome. : A cohort study of 31 patients with CD received GKRS in West China Hospital between June 2010 and December 2021. Endocrine remission was defined as normalization of 24 h urinary free cortisol (UFC) or serum cortisol ≤ 50 nmol/L after a 1 mg dexamethasone suppression test. : The mean age was 38.6 years old, and females accounted for 77.4%. GKRS was the initial treatment for 21 patients (67.7%), and 32.3% of patients underwent GKRS after surgery due to residual disease and recurrence. The mean endocrine follow-up duration was 22 months. The median marginal dose was 28.0 Gy, and the median BED was 221.5 Gy. Fourteen patients (45.1%) experienced control of hypercortisolism in the absence of pharmacological treatment, and the median duration to remission was 20.0 months. The cumulative rates of endocrine remission at 1, 2, and 3 years after GKRS were 18.9%, 55.3%, and 72.21%, respectively. The total complication rate was 25.8%, and the mean duration from GKRS to hypopituitary was 17.5 months. The new hypopituitary rate at 1, 2, and 3 years were 7.1%, 30.3%, and 48.4%, respectively. A high BED level (BED > 205 Gy) was associated with better endocrine remission than a low BED level (BED ≤ 205 Gy), while no significant differences were found between the BED level and hypopituitarism. GKRS was a second-line therapeutic option for CD with satisfactory safety and efficacy. BED should be considered during GKRS treatment planning, and optimization of BED is a potentially impactful avenue toward improving the efficacy of GKRS.
几十年来，伽玛刀放射外科手术（GKRS）一直作为库欣病（CD）的辅助治疗方法，并且已成为CD治疗的重要组成部分。生物有效剂量（BED）是一个经过时间校正的放射生物学参数，考虑了细胞脱氧核糖核酸修复情况。我们旨在研究GKRS治疗CD的安全性和有效性，并评估BED与治疗结果之间的关联。
对2010年6月至2021年12月期间在华西医院接受GKRS治疗的31例CD患者进行队列研究。内分泌缓解定义为24小时尿游离皮质醇（UFC）正常化或在1毫克地塞米松抑制试验后血清皮质醇≤50纳摩尔/升。
平均年龄为38.6岁，女性占77.4%。21例患者（67.7%）将GKRS作为初始治疗，32.3%的患者因残留疾病和复发在手术后接受GKRS治疗。平均内分泌随访时间为22个月。中位边缘剂量为28.0 Gy，中位BED为221.5 Gy。14例患者（45.1%）在未接受药物治疗的情况下实现了高皮质醇血症的控制，缓解的中位持续时间为20.0个月。GKRS术后1年、2年和3年的内分泌缓解累积率分别为18.9%、55.3%和72.21%。总并发症发生率为25.8%，从GKRS到垂体功能减退的平均时间为17.5个月。1年、2年和3年的新垂体功能减退率分别为7.1%、30.3%和48.4%。与低BED水平（BED≤205 Gy）相比，高BED水平（BED>205 Gy）与更好的内分泌缓解相关，而BED水平与垂体功能减退之间未发现显著差异。GKRS是CD的二线治疗选择，具有令人满意的安全性和有效性。在GKRS治疗计划中应考虑BED，优化BED是提高GKRS疗效的一个潜在有效途径。
