Repeat stereotactic radiosurgery for Cushing’s disease: outcomes of an international, multicenter study

Gautam U. Mehta, Dale Ding, Amitabh Gupta, Hideyuki Kano, Nathaniel D. Sisterson, Nuria Martinez-Moreno, Michal Kršek, Huai Che Yang, Cheng Chia Lee, Roman Liščák, Roberto Martinez-Alvarez, L. Dade Lunsford, Mary Lee Vance, Jason P. Sheehan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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. We sought to determine the outcomes of repeat SRS in patients with CD. We pooled data from five institutions participating in the International Gamma Knife Research Foundation 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 were included in the study. Repeat single-session SRS was performed 1.3–9.7 years after initial SRS. Median endocrine follow-up was 6.6 years (1.4–19.1 years). Median margin dose was 20 Gy (range 10.8–35 Gy). Endocrine remission after second SRS was noted in 12 patients (60%), with a median time to remission of 6 months (range 2–64 months). Biochemical recurrence occurred in two patients (17%) after initial remission. Overall, the cumulative rates of durable endocrine remission at 5 and 10 years were 47 and 53%, respectively. Two patients (10%) experienced adverse radiation effects, including transient visual loss and permanent diplopia. 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.

Original languageEnglish
Pages (from-to)519-525
Number of pages7
JournalJournal of Neuro-Oncology
Issue number3
StatePublished - 1 Jul 2018


  • Adrenocorticotropic hormone
  • Cushing’s disease
  • Gamma knife
  • Pituitary adenoma
  • Radiosurgery


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