Role of Gamma Knife Radiosurgery in the Treatment of Prolactinomas

Overview

Journal Pituitary

Specialty Endocrinology

Date 2019 Jun 22

PMID 31222579

Citations 10

Authors

Jana Jezkova

Vaclav Hana

Mikulas Kosak

Michal Krsek

Roman Liscak

Josef Vymazal

Ladislav Pecen

Josef Marek

Affiliations

Soon will be listed here.

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.

Citing Articles

Long-term tumor control following gamma-knife radiosurgery of recurrent or residual pituitary adenomas: a population-based cohort study.

Gabri A, Lindberg F, Kristiansson H, Gubanski M, Hoybye C, Olsson M Acta Neurochir (Wien). 2024; 166(1):488.

PMID: 39613987 PMC: 11607058. DOI: 10.1007/s00701-024-06380-9.

Radiation therapy in functioning and no functioning pituitary neuroendocrine tumor: systematic review of the recent literature after 2011.

Hemaidia R, Cebula H, Goichot B, Noel G Front Endocrinol (Lausanne). 2024; 15:1468724.

PMID: 39600946 PMC: 11590027. DOI: 10.3389/fendo.2024.1468724.

Hypopituitarism after gamma knife radiosurgery for pituitary adenomas: long-term results from a single-center experience.

Yu J, Fu J, Li Y, Hu G, Hu G, Hu W BMC Cancer. 2024; 24(1):963.

PMID: 39107688 PMC: 11301991. DOI: 10.1186/s12885-024-12735-3.

Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment.

Dzialach L, Sobolewska J, Zak Z, Respondek W, Witek P Front Endocrinol (Lausanne). 2024; 15:1338345.

PMID: 38370355 PMC: 10870150. DOI: 10.3389/fendo.2024.1338345.

Stereotactic Radiosurgery Outcomes in Medically and Surgically Failed or Nonsurgical Candidates with Medically Failed Prolactinomas: A Systematic Review and Meta-Analysis.

Yagnik K, Erickson D, Bancos I, Choby G, Laack N, Van Gompel J J Neurol Surg B Skull Base. 2023; 84(6):538-547.

PMID: 37854534 PMC: 10581828. DOI: 10.1055/a-1934-9028.

References

OConnor M, Mayberg M . Effects of radiation on cerebral vasculature: a review. Neurosurgery. 2000; 46(1):138-49; discussion 150-1. DOI: 10.1093/neurosurgery/46.1.138. View

Mokry M, Ramschak-Schwarzer S, Simbrunner J, Ganz J, Pendl G . A six year experience with the postoperative radiosurgical management of pituitary adenomas. Stereotact Funct Neurosurg. 2000; 72 Suppl 1:88-100. DOI: 10.1159/000056444. View

Kim S, Huh R, Chang J, Park Y, Chung S . Gamma Knife radiosurgery for functioning pituitary adenomas. Stereotact Funct Neurosurg. 2000; 72 Suppl 1:101-10. DOI: 10.1159/000056445. View

Hayashi M, Izawa M, Hiyama H, Nakamura S, Atsuchi S, Sato H . Gamma Knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg. 2000; 72 Suppl 1:111-8. DOI: 10.1159/000056446. View

Pan L, Zhang N, Wang E, Wang B, Dai J, Cai P . Gamma knife radiosurgery as a primary treatment for prolactinomas. J Neurosurg. 2001; 93 Suppl 3:10-3. DOI: 10.3171/jns.2000.93.supplement. View

LANDOLT A, Lomax N . Gamma knife radiosurgery for prolactinomas. J Neurosurg. 2001; 93 Suppl 3:14-8. DOI: 10.3171/jns.2000.93.supplement. View

Di Sarno A, Landi M, Cappabianca P, Di Salle F, Rossi F, Pivonello R . Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: prevalence, clinical definition, and therapeutic strategy. J Clin Endocrinol Metab. 2001; 86(11):5256-61. DOI: 10.1210/jcem.86.11.8054. View

Ikeda H, Jokura H, Yoshimoto T . Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg. 2002; 95(2):285-91. DOI: 10.3171/jns.2001.95.2.0285. View

Verges B, Boureille F, Goudet P, Murat A, Beckers A, Sassolas G . Pituitary disease in MEN type 1 (MEN1): data from the France-Belgium MEN1 multicenter study. J Clin Endocrinol Metab. 2002; 87(2):457-65. DOI: 10.1210/jcem.87.2.8145. View

10.

Pollock B, Nippoldt T, Stafford S, Foote R, Abboud C . Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg. 2002; 97(3):525-30. DOI: 10.3171/jns.2002.97.3.0525. View

11.

Feigl G, Bonelli C, Berghold A, Mokry M . Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg. 2003; 97(5 Suppl):415-21. DOI: 10.3171/jns.2002.97.supplement. View

12.

Vladyka V, Liscak R, Novotny Jr J, Marek J, Jezkova J . Radiation tolerance of functioning pituitary tissue in gamma knife surgery for pituitary adenomas. Neurosurgery. 2003; 52(2):309-16; discussion 316-7. DOI: 10.1227/01.neu.0000043709.53906.31. View

13.

Petrovich Z, Yu C, Giannotta S, Zee C, Apuzzo M . Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery. 2003; 53(1):51-9; discussion 59-61. DOI: 10.1227/01.neu.0000068702.00330.47. View

14.

Webster J, Piscitelli G, Polli A, DALBERTON A, Falsetti L, Ferrari C . Dose-dependent suppression of serum prolactin by cabergoline in hyperprolactinaemia: a placebo controlled, double blind, multicentre study. European Multicentre Cabergoline Dose-finding Study Group. Clin Endocrinol (Oxf). 1992; 37(6):534-41. DOI: 10.1111/j.1365-2265.1992.tb01485.x. View

15.

Choi J, Chang J, Chang J, Ha Y, Park Y, Chung S . Radiological and hormonal responses of functioning pituitary adenomas after gamma knife radiosurgery. Yonsei Med J. 2003; 44(4):602-7. DOI: 10.3349/ymj.2003.44.4.602. View

16.

Kuo J, Chen J, Yu C, Zelman V, Giannotta S, Petrovich Z . Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery. 2004; 54(6):1385-93. DOI: 10.1227/01.neu.0000124750.13721.94. View

17.

Sheehan J, Niranjan A, Sheehan J, Jane Jr J, Laws E, Kondziolka D . Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg. 2005; 102(4):678-91. DOI: 10.3171/jns.2005.102.4.0678. View

18.

Berinder K, Stackenas I, Akre O, Linden Hirschberg A, Hulting A . Hyperprolactinaemia in 271 women: up to three decades of clinical follow-up. Clin Endocrinol (Oxf). 2005; 63(4):450-5. DOI: 10.1111/j.1365-2265.2005.02364.x. View

19.

Jezkova J, Marek J, Hana V, Krsek M, Weiss V, Vladyka V . Gamma knife radiosurgery for acromegaly--long-term experience. Clin Endocrinol (Oxf). 2006; 64(5):588-95. DOI: 10.1111/j.1365-2265.2006.02513.x. View

20.

Gillam M, Molitch M, Lombardi G, Colao A . Advances in the treatment of prolactinomas. Endocr Rev. 2006; 27(5):485-534. DOI: 10.1210/er.2005-9998. View