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Pituitary

, Volume 22, Issue 4, pp 411–421 | Cite as

Role of gamma knife radiosurgery in the treatment of prolactinomas

  • Jana JežkováEmail author
  • Václav Hána
  • Mikuláš Kosák
  • Michal Kršek
  • Roman Liščák
  • Josef Vymazal
  • Ladislav Pecen
  • Josef Marek
Article
  • 36 Downloads

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.

Keywords

Gamma knife radiosurgery Prolactinoma Resistance Hypopituitarism 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Third Department of Medicine, First Faculty of MedicineCharles University and General University HospitalPragueCzech Republic
  2. 2.Second Department of Medicine, Third Faculty of MedicineCharles University and University Hospital Královské VinohradyPragueCzech Republic
  3. 3.Stereotactic and Radiation NeurosurgeryNa Homolce HospitalPragueCzech Republic
  4. 4.Radiodiagnostic DepartmentNa Homolce HospitalPragueCzech Republic
  5. 5.Institute of Informatics of the Czech Academy of SciencePragueCzech Republic

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