Results for LINAC-based radiosurgery or fractionated stereotactic radiotherapy for corticotropic pituitary tumors: a single-center retrospective cohort.

BACKGROUND

Radiotherapy (RT) plays an important role in the treatment of persistent or recurrent Cushing disease (CD) after primary surgery. We assessed the results for RT using a linear accelerator based (LINAC) stereotactic technique. Primary objectives were progression-free survival (PFS) and time to hormonal disease control (THC).

METHODS

Single-center retrospective cohort in a tertiary, academic hospital assessed between 2008 and 2023.

RESULTS

Fifty-nine patients (59) patients were assessed. Mean age was 41.9 years (range: 15 to 72 years). Most were female (79.7%). Median lesion size at first visit was 1.49 cm (range: 0.3 to 5.2 cm). Patients were either treated with fractionated RT (50.8%) or single-fraction radiosurgery (SRS). Cabergoline was used prior (49.2%) and concurrently to RT (38.9%). Ketoconazole during SRT was also largely used (30.5%). Median follow-up was 69.9 months. There were no reported deaths. Median PFS was not reached, mean was 78.5 months. Disease control was reported in 94.9% of patients. Only 3 (5.1%) acquired new hormonal deficits. Univariate analysis showed that no variable impacted either PFS or tumor response. Criteria for hormonal remission at 12 months were reached in 33.9%. Median THC was 37.1 months (interquartile interval 25% 8.2 months to 75% 153.5 months). There were two new cardiac events during follow-up and new Cushing stigmata arise on two patients (3.3%).

CONCLUSION

We achieved good results for LINAC-based RT in this large, single center cohort with high tumor control. Among patients with CD treatment options impacted neither PFS nor cure rate in this study.