Published in:
01-12-2015
Gamma Knife radiosurgery for medically and surgically refractory prolactinomas: long-term results
Published in: Pituitary | Issue 6/2015
Login to get accessAbstract
Introduction
Prolactinomas are the most common functioning pituitary adenomas. Dopamine agonists (DA) are generally very effective in treating prolactinomas by inducing tumor volume regression and endocrine remission. A minority of patients do not respond to DA or are intolerant because of side-effects. Microsurgical resection when possible is the next treatment option, but cavernous sinus, dural, or bone involvement may not allow for complete resection.
Objective
We reviewed the outcome of patients with medically and surgically refractory prolactinomas treated with Gamma Knife radiosurgery (GKRS) during a 22 years follow-up period.
Methods
We reviewed the patient database at the University of Virginia Gamma Knife center during a 25-year period (1989–2014), identifying 38 patients having neurosurgical, radiological and endocrine follow-up.
Results
Median age at GKRS treatment was 43 years. Median follow-up was 42.3 months (range 6–207.9). 55.3 % (n = 21) were taking a dopamine agonist at time of GKRS. 63.2 % (n = 24) had cavernous sinus tumor invasion. Endocrine remission (normal serum prolactin off of a dopamine agonist) was achieved in 50 % (n = 19). GKRS induced hypopituitarism occurred in 30.3 % (n = 10). Cavernous sinus involvement was shown to be a significant negative prognosticator of endocrine remission. Taking a dopamine agonist drug at the time of GKRS showed a tendency to decrease the probability for endocrine remission.
Conclusion
GKRS for refractory prolactinomas can lead to endocrine remission in many patients. Hypopituitarism is the most common side effect of GKRS.