External radiation therapy (RT) directed to the pituitary gland is generally recommended in patients with Cushing’s disease (CD) as adjuvant to transsphenoidal surgery, among other second-line therapies offered to patients with residual or recurrent hypercortisolism (i.e., medical treatment, repeat surgery or bilateral adrenalectomy). RT is effective for the control of tumor growth, even in invasive tumors and in Nelson’s syndrome. Progress in radiation stereotactic techniques lead to improved tumor targeting and radiation delivery, thus sparing the adjacent brain structures. Stereotactic RT is associated with a 55–65% rate of cortisol normalization after several months to a few years and potentially with a lower risk of long-term complications, compared with conventional RT. Cortisol-lowering medical therapy is recommended while awaiting the radiation effects. Hypopituitarism is the most frequent side-effect, damage to optic or cranial nerves or second brain tumors are rarely reported. This review presents the updates in the efficacy and safety of the stereotactic radiation techniques in CD patients. Practical points which should be considered by the clinician before recommending RT are also presented.

库欣病 (CD) 患者通常推荐针对垂体的外部放射治疗 (RT) 作为经蝶手术的辅助治疗，以及为残留或复发性皮质醇增多症患者提供的其他二线治疗（即药物治疗、重复手术）或双侧肾上腺切除术）。放疗可有效控制肿瘤生长，即使在侵袭性肿瘤和纳尔逊综合征中也是如此。放射立体定向技术的进步改善了肿瘤靶向和放射递送，从而保护了相邻的大脑结构。与传统放疗相比，立体定向放疗在几个月到几年后与 55-65% 的皮质醇正常化率相关，并且可能具有较低的长期并发症风险。建议在等待放射效应期间使用降低皮质醇的药物治疗。垂体功能减退是最常见的副作用，很少报道视神经或颅神经受损或第二脑肿瘤。本综述介绍了立体定向放射技术在 CD 患者中的有效性和安全性的更新。还介绍了临床医生在推荐放疗前应考虑的实际要点。