• Matthew J Shepard, Gautam U Mehta, Zhiyuan Xu, Hideyuki Kano, Nathaniel Sisterson, Yan-Hua Su, Michal Krsek, Ahmed M Nabeel, Amr El-Shehaby, Khaled A Kareem, Nuria Martinez-Moreno, David Mathieu, Brendan J McShane, Kevin Blas, Douglas Kondziolka, Inga Grills, John Y Lee, Roberto Martinez-Alvarez, Wael A Reda, Roman Liscak, Cheng-Chia Lee, L Dade Lunsford, Lee Vance Mary M Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA., and Jason P Sheehan.
• Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
• World Neurosurg. 2018 Aug 1; 116: e670-e679.

BackgroundStereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS.MethodsAn international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS.ResultsA total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm3, and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS and those who underwent discreet adenoma-targeted SRS.ConclusionsWhole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS.Copyright © 2018 Elsevier Inc. All rights reserved.

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