Outcomes of stereotactic radiosurgery in nelson's syndrome: a systematic review and Meta-Analysis.

BACKGROUND

Nelson's syndrome (NS) is an uncommon but serious complication after bilateral adrenalectomy (BA) in patients with Cushing's disease (CD). Stereotactic radiosurgery (SRS) has increasingly been used as a treatment option for NS patients; however, its effectiveness and safety remain uncertain. This meta-analysis aims to assess the role of SRS in NS.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched through June 11, 2025, for studies reporting outcomes of SRS in NS. Pooled estimates were calculated for local control (LC), endocrine remission (ER), new pituitary dysfunction (NPD), salvage treatment (ST), and adverse radiation effects (ARE).

RESULTS

Seven studies with 122 patients were included. Pooled LC was 95% (95% CI: 89-99%), ER was 21% (95% CI: 13-30%), NPD was 20% (95% CI: 11-31%), ST was 4% (95% CI: 0-9%), and ARE was 0% (95% CI: 0-11%). Meta-regression analysis revealed that larger lesion volume, longer interval from prior resection, and higher pre-SRS ACTH levels were significantly associated with an increased risk of ARE.

CONCLUSION

SRS provides high local control rates and a low safety risk for NS patients, although endocrine remission remains limited. These results support SRS as a viable choice in multidisciplinary management, although further prospective studies are needed.