TY - JOUR
T1 - Treatment of recurrent and persistent Cushing’s disease after first transsphenoidal surgery
T2 - lessons learned from an international meta-analysis
AU - Perez-Vega, Carlos
AU - Ramos-Fresnedo, Andres
AU - Tripathi, Shashwat
AU - Domingo, Ricardo A.
AU - Ravindran, Krishnan
AU - Almeida, Joao P.
AU - Peterson, Jennifer
AU - Trifiletti, Daniel M.
AU - Chaichana, Kaisorn L.
AU - Quinones-Hinojosa, Alfredo
AU - Samson, Susan L.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/6
Y1 - 2022/6
N2 - Purpose: Transsphenoidal surgery (TSS) is the first-line treatment for patients with Cushing’s Disease (CD). Recurrence rates after a first TSS range between 3 and 22% within 3 years. Management of recurrent or persistent CD may include repeat TSS or stereotactic radiosurgery (SRS). We performed a meta-analysis to explore the overall efficacy of TSS and SRS for patients with CD after an initial surgical intervention. Methods: EMBASE, PubMed, SCOPUS, and Cochrane databases were searched from their dates-of-inception up to December 2021. Inclusion criteria were comprised of patients with an established diagnosis of CD who presented with persistent or biochemically recurrent disease after a first TSS for tumor resection and were treated with a second TSS or SRS. Results: Search criteria yielded 2,116 studies of which 37 articles from 15 countries were included for analysis. Mean age ranged between 29.9 and 47.9 years, and mean follow-up was 11–104 months. TSS was used in 669 (67.7%) patients, while SRS was used in 320 (32.4%) patients, and remission rates for CD were 59% (95%CI 0.49–0.68) and 74% (95%CI 0.54–0.88), respectively. There was no statistically significant difference in the remission rate between TSS and SRS (P = 0.15). The remission rate of patients with recurrent CD undergoing TSS was 53% (95%CI 0.32–0.73), and for persistent CD was 41% (95%CI 0.28–0.56) (P = 0.36). Conclusion: Both TSS and SRS are possible approaches for the treatment of recurrent or persistent CD after a first TSS. Our data show that either TSS or SRS represent viable treatment options to achieve remission for this subset of patients.
AB - Purpose: Transsphenoidal surgery (TSS) is the first-line treatment for patients with Cushing’s Disease (CD). Recurrence rates after a first TSS range between 3 and 22% within 3 years. Management of recurrent or persistent CD may include repeat TSS or stereotactic radiosurgery (SRS). We performed a meta-analysis to explore the overall efficacy of TSS and SRS for patients with CD after an initial surgical intervention. Methods: EMBASE, PubMed, SCOPUS, and Cochrane databases were searched from their dates-of-inception up to December 2021. Inclusion criteria were comprised of patients with an established diagnosis of CD who presented with persistent or biochemically recurrent disease after a first TSS for tumor resection and were treated with a second TSS or SRS. Results: Search criteria yielded 2,116 studies of which 37 articles from 15 countries were included for analysis. Mean age ranged between 29.9 and 47.9 years, and mean follow-up was 11–104 months. TSS was used in 669 (67.7%) patients, while SRS was used in 320 (32.4%) patients, and remission rates for CD were 59% (95%CI 0.49–0.68) and 74% (95%CI 0.54–0.88), respectively. There was no statistically significant difference in the remission rate between TSS and SRS (P = 0.15). The remission rate of patients with recurrent CD undergoing TSS was 53% (95%CI 0.32–0.73), and for persistent CD was 41% (95%CI 0.28–0.56) (P = 0.36). Conclusion: Both TSS and SRS are possible approaches for the treatment of recurrent or persistent CD after a first TSS. Our data show that either TSS or SRS represent viable treatment options to achieve remission for this subset of patients.
KW - Cushing’s disease
KW - Pituitary adenoma
KW - Stereotactic radiosurgery
KW - Transsphenoidal surgery
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U2 - 10.1007/s11102-022-01215-1
DO - 10.1007/s11102-022-01215-1
M3 - Article
C2 - 35508745
AN - SCOPUS:85129638411
SN - 1386-341X
VL - 25
SP - 540
EP - 549
JO - Pituitary
JF - Pituitary
IS - 3
ER -