Newswise — Winner of the American Brain Tumor Association Young Investigator Award, Gautam Unmeel Mehta, MD, presented his research, Repeat Stereotactic Radiosurgery for Cushing’s Disease: Outcomes of an International, Multicenter Study, during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.

Stereotactic radiosurgery (SRS) is frequently used for Cushing’s disease (CD) after failed pituitary surgery. Management of patients with persistent CD after failed SRS is complex, as the alternative therapeutic options harbor significant risks. The outcomes of repeat pituitary radiosurgery, however, have not been described.

In conducting this research, data was pooled from five institutions participating in the International Gamma Knife Research Foundation (IGKRF) for patients with recurrent or persistent CD ≥ 12 months after initial SRS. Patients were included in the study if they had ≥ 6 months endocrine follow-up after repeat SRS.

Twenty patients (80 percent female) were included in the study. Repeat SRS was performed 1.3 to 9.7 years after initial SRS. Median endocrine follow-up was 6.6 years (1.4-19.1 years). Median margin dose was 20 Gy (range 10.8 to 35 Gy). Endocrine remission after second SRS was noted in 12 patients (60 percent), with a median time to remission of six months (range: 2-64 months). Biochemical recurrence occurred in two patients (17 percent) after initial remission. Overall, the cumulative rates of durable endocrine remission at five and 10 years were 47 and 53 percent, respectively. Two patients (10 percent) experienced adverse radiation effects, including transient vision loss and permanent diplopia.

Results of the study indicate that repeat SRS achieves lasting biochemical remission in approximately half of patients with CD refractory to both prior microsurgery and SRS. Because of the morbidity of refractory or recurrent CD, repeat SRS should be considered for carefully selected patients with hypercortisolism confirmed one or more years after initial SRS.

Author Block: Dale Ding; Amitabh Gupta; Hideyuki Kano; Michal Krsek; Cheng-Chia Lee; Roman Liscak; Roberto Martinez-Alvarez; L. Dade Lunsford; Mary Lee Vance; Jason Sheehan

Disclosure: The author reported no conflicts of interest.

 

Media Representatives: The 2018 AANS Annual Scientific Meeting website’s press section will include releases on highlighted scientific research, AANS officers and award winners, Neurosurgery Awareness Month and other relevant information about the 2018 program. Releases will be posted on the 2018 AANS Annual Scientific Meeting website. If you have interest in a topic related to neurosurgery or would like to interview a neurosurgeon — either onsite or via telephone — during the event, please contact Alice Kelsey, AANS associate executive director, via email at [email protected].

 

About the 2018 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations accepted for the 2018 event will represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Find additional information about the 2018 AANS Annual Scientific Meeting and the meeting program here.

 

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

 

For more information, visit www.AANS.org.