Treatment of recurrent and persistent Cushing’s disease after first transsphenoidal surgery: lessons learned from an international meta-analysis
- 04.05.2022
Erschienen in:
- Verfasst von
- Carlos Perez-Vega
- Andres Ramos-Fresnedo
- Shashwat Tripathi
- Ricardo A. Domingo
- Krishnan Ravindran
- Joao P. Almeida
- Jennifer Peterson
- Daniel M. Trifiletti
- Kaisorn L. Chaichana
- Alfredo Quinones-Hinojosa
- Susan L. Samson
- Erschienen in
- Pituitary | Ausgabe 3/2022
Abstract
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.
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- Titel
- Treatment of recurrent and persistent Cushing’s disease after first transsphenoidal surgery: lessons learned from an international meta-analysis
- Verfasst von
-
Carlos Perez-Vega
Andres Ramos-Fresnedo
Shashwat Tripathi
Ricardo A. Domingo
Krishnan Ravindran
Joao P. Almeida
Jennifer Peterson
Daniel M. Trifiletti
Kaisorn L. Chaichana
Alfredo Quinones-Hinojosa
Susan L. Samson
- Publikationsdatum
- 04.05.2022
- Verlag
- Springer US
- Erschienen in
-
Pituitary / Ausgabe 3/2022
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403 - DOI
- https://doi.org/10.1007/s11102-022-01215-1
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