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Gamma Knife radiosurgery for medically and surgically refractory prolactinomas: long-term results

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Abstract

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.

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Acknowledgments

Multiple clinicians have contributed to this radiosurgery experience. We would like to thank Drs. Edward Laws, Edward H. Oldfield, John Jane Jr., Michael Thorner, John Marshall, and Gregory Hong and referring physicians for their efforts in the treatment and follow up of these patients.

Conflict of interest

The authors have no personal or institutional financial interest in drugs or materials in relation to this paper.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA

    Or Cohen-Inbar, Zhiyuan Xu, David Schlesinger, Mary Lee Vance & Jason P. Sheehan

  2. Department of Medicine, University of Virginia, Charlottesville, VA, USA

    Mary Lee Vance

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  1. Or Cohen-Inbar
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  2. Zhiyuan Xu
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Correspondence to Or Cohen-Inbar.

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Cohen-Inbar, O., Xu, Z., Schlesinger, D. et al. Gamma Knife radiosurgery for medically and surgically refractory prolactinomas: long-term results. Pituitary 18, 820–830 (2015). https://doi.org/10.1007/s11102-015-0658-1

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