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Pituitary
Published in: Pituitary 4/2019

01-08-2019 | Prolactinoma

Role of gamma knife radiosurgery in the treatment of prolactinomas

Authors: Jana Ježková, Václav Hána, Mikuláš Kosák, Michal Kršek, Roman Liščák, Josef Vymazal, Ladislav Pecen, Josef Marek

Published in: Pituitary | Issue 4/2019

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Abstract

Purpose

Stereotactic radiosurgery is one of the treatment options for prolactinomas, the most commonly used being Gamma Knife Radiosurgery (GKRS). GKRS is indicated mainly in the treatment of dopamine agonist (DA)-resistant prolactinomas. In our study, we report on our experience in treating prolactinoma patients by GKRS.

Methods

Twenty-eight patients were followed-up after GKRS for 26–195 months (median 140 months). Prior to GKRS, patients were treated with DAs and 9 of them (32.1%) underwent previous neurosurgery. Cavernous sinus invasion was present in 16 (57.1%) patients. Indications for GKRS were (i) resistance to DA treatment (17 patients), (ii) drug intolerance (5 patients), or (iii) attempts to reduce the dosage and/or shorten the length of DA treatment (6 patients).

Results

After GKRS, normoprolactinaemia was achieved in 82.1% of patients, out of which hormonal remission (normoprolactinaemia after discontinuation of DAs) was achieved in 13 (46.4%), and hormonal control (normoprolactinaemia while taking DAs) in 10 (35.7%) patients. GKRS arrested adenoma growth or decreased adenoma size in all cases. Two patients (8.3%) developed hypopituitarism after GKRS. Prolactinoma cystic transformation with expansive behaviour, manifested by bilateral hemianopsia, was observed in one patient.

Conclusions

GKRS represents an effective treatment option, particularly for DA-resistant prolactinomas. Normoprolactinaemia was achieved in the majority of patients, either after discontinuation of, or while continuing to take, DAs. Tumour growth was arrested in all cases. The risk of the development of hypopituitarism can be limited if the safe dose to the pituitary and infundibulum is maintained.
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Metadata
Title
Role of gamma knife radiosurgery in the treatment of prolactinomas
Authors
Jana Ježková
Václav Hána
Mikuláš Kosák
Michal Kršek
Roman Liščák
Josef Vymazal
Ladislav Pecen
Josef Marek
Publication date
01-08-2019
Publisher
Springer US
Published in
Pituitary / Issue 4/2019
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-019-00971-x

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