{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T03:23:12Z","timestamp":1770434592489,"version":"3.49.0"},"reference-count":33,"publisher":"The Endocrine Society","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Context: Radiation therapy is a potentially curative treatment for corticotroph adenomas refractory to surgery. Protons have an advantage over photons (x-rays) by depositing energy at the target with no exit dose, providing a lower dose to adjacent normal tissues. Until recently, proton stereotactic radiotherapy (PSR) was available at only two U.S. centers; use will increase as proton facilities are under development.<\/jats:p>\n               <jats:p>Objective: Our objective was to evaluate the efficacy and safety of PSR for persistent Cushing\u2019s disease (CD) and Nelson\u2019s syndrome (NS).<\/jats:p>\n               <jats:p>Design: This was a retrospective review of 38 patients (33 with CD and five with NS) treated between 1992 and 2005.<\/jats:p>\n               <jats:p>Participants: All patients had transsphenoidal surgery without biochemical cure. Four had previous irradiation with photons. The patients with NS underwent bilateral adrenalectomy 29\u2013228 months (median 40) before PSR.<\/jats:p>\n               <jats:p>Intervention: Single-fraction PSR was delivered at a median dose of 20 Cobalt Gray Equivalents (range 15\u201320) on 1 treatment day.<\/jats:p>\n               <jats:p>Main Outcome Measures: Complete response (CR) was defined as sustained (\u22653 months) normalization of urinary free cortisol off medical therapy. CR in NS was based on normalization of plasma corticotropin.<\/jats:p>\n               <jats:p>Results: At a median follow-up of 62 months (range 20\u2013136), CR was achieved in five patients (100%) with NS and 17 (52%) patients with CD. Among all patients with CR, median time to CR was 18 months (range 5\u201349). No secondary tumors were noted on follow-up magnetic resonance imaging scans, and there was no clinical evidence of optic nerve damage, seizure, or brain injury. There were 17 patients (52%) who developed new pituitary deficits.<\/jats:p>\n               <jats:p>Conclusions: PSR is effective for patients with persistent corticotroph adenomas with low morbidity after a median follow-up of 62 months; longer follow-up is warranted for late radiation-related sequelae.<\/jats:p>","DOI":"10.1210\/jc.2007-1220","type":"journal-article","created":{"date-parts":[[2007,11,21]],"date-time":"2007-11-21T01:48:35Z","timestamp":1195609715000},"page":"393-399","source":"Crossref","is-referenced-by-count":100,"title":["Proton Stereotactic Radiotherapy for Persistent Adrenocorticotropin-Producing Adenomas"],"prefix":"10.1210","volume":"93","author":[{"given":"Joshua H.","family":"Petit","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology (J.H.P., T.I.Y., J.J.C., M.A., M.B., J.S.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beverly M. 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