6. Stereotactic radiosurgery using Gamma Knife for Itsenko-Cushing's disease

Аннотация

Stereotactic Gamma Knife radiosurgery is becoming the treatment of choice for patients with Cushing's disease that cannot be cured by surgery. The chances of 5-year remission are 65-75%, and control of tumor growth reaches more than 90%. However, the development of hypopituitarism (15% to 36%) is a common side effect, and severe neurological complications are rare. Relapse of the disease occurs in 16-18% of patients, but the reasons for this are unclear. Stereotactic Gamma Knife radiosurgery is effective as second line therapy in surgically untreated patients. The purpose of the study is to evaluate the effectiveness of stereotactic gamma knife radiosurgery as an adjuvant treatment for Cushing's disease, and also to consider possible complications and undesirable effects associated with the use of Stereotactic Gamma Knife radiosurgery in the treatment of Cushing’s disease. The authors analyzed the published results of international, multicenter and retrospective cohort studies on the use of Stereotactic Gamma Knife radiosurgery in patients with. According to published data, the average time to achieve remission after Stereotactic Gamma Knife radiosurgery in patients with Cushing’s disease was 16-17 months, while remission was maintained for 10 years in 60-80% of patients. Tumor growth control was achieved in 95% of cases. Our article suggests that radiosurgery is a safe and well-tolerated procedure and can provide long-term control of hypercortisolism in the majority of patients with Cushing’s disease. However, given the likelihood of relapse after initial normalization of cortisol levels and the manifestation of hypopituitarism, long-term endocrine monitoring after radiosurgery is necessary. Ultimately, radiosurgery may be considered a reasonable primary treatment option for carefully selected patients who cannot have another treatment.