SFEBES2016 Poster Presentations Neuroendocrinology and pituitary (34 abstracts)
Stereotactic radiosurgery as salvage therapy in refractory Cushings’s disease: long term outcome from a single institution
Kirun Gunganah 1 , Mohammed Abdalla 1 , S A Akker 1 , S J B Aylwin 2 , P N Plowman 1 , J P Monson 1 , Ian Sabin 1 & W M Drake 1
1Department of Endocrinology, St Bartholomew’s Hospital, London, UK; 2Department of Endocrinology, Kings College Hospital NHS Trust, London, UK.
Background: Untreated Cushing’s disease has a high mortality rate. Transsphenoidal surgery is usually first line treatment and in the hands of a skilled experienced surgeon can achieve a cure rate of up to 80%. For those with recurrent or un-resectable disease, a combination of external beam radiotherapy, stereotactic radiotherapy, repeat transsphenoidal surgery, bilateral adrenalectomy and chemotherapy may be used. We investigated the safety and efficacy of stereotactic radiosurgery as salvage therapy in patients with recurrent Cushings’s disease refractory to a combination of conventional treatments.
Method: This was a single-centre retrospective study of patients with recurrent Cushing’s disease following a combination of surgery, external beam radiotherapy and/or chemotherapy, treated with stereotactic radiosurgery. We investigated achievement of biochemical and radiological control as well as clinical outcomes and adverse effects of stereotactic radiosurgery.
Result: From 2000 to 2016, 14 patients met our criteria. They were followed up for a median of 5 years (12–96 months). Following stereotactic radiosurgery, cortisol control was achieved in 86% of patients (12 out of 14) and reduction in tumour volume was seen in 79% of patients (11 out of 14). Three patients died due a combination of tumour progression and complications of cortisol excess (36, 60 and 72 months after stereotactic radiosurgery). One patient had recurrence of disease 5 years following initial biochemical and radiological control after stereotactic radiosurgery. Main adverse events included hypopituitarism (9 out of 14), neuromytonia (2 out of 14) and stroke (1 out of 14).
Conclusion: Stereotactic radiosurgery is an effective and safe treatment option for patients with Cushing’s disease refractory to conventional therapies. Hypopituitarism was the main adverse event. Longer term follow-up is required to determine the recurrence rate of Cushing’s disease post stereotactic surgery in this group of patient.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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