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Role of gamma knife radiosurgery in the treatment of prolactinomas

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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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Authors and Affiliations

  1. Third Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 1, 128 02, Prague, Czech Republic

    Jana Ježková, Václav Hána, Mikuláš Kosák, Michal Kršek & Josef Marek

  2. Second Department of Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic

    Michal Kršek

  3. Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    Roman Liščák

  4. Radiodiagnostic Department, Na Homolce Hospital, Prague, Czech Republic

    Josef Vymazal

  5. Institute of Informatics of the Czech Academy of Science, Prague, Czech Republic

    Ladislav Pecen

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  1. Jana Ježková
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  2. Václav Hána
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Correspondence to Jana Ježková.

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Ježková, J., Hána, V., Kosák, M. et al. Role of gamma knife radiosurgery in the treatment of prolactinomas. Pituitary 22, 411–421 (2019). https://doi.org/10.1007/s11102-019-00971-x

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