The most common functioning pituitary adenoma is prolactinoma. Patients with medically refractory or residual/recurrent tumors that are not amenable to resection can be treated with stereotactic radiosurgery (SRS). The aim of this multicenter study was to evaluate the role of SRS for treating prolactinomas.
This retrospective study included prolactinomas treated with SRS between 1997 and 2016 at ten institutions. Patients’ clinical and treatment parameters were investigated. Patients were considered to be in endocrine remission when they had a normal level of prolactin (PRL) without requiring dopamine agonist medications. Endocrine control was defined as endocrine remission or a controlled PRL level ≤ 30 ng/ml with dopamine agonist therapy. Other outcomes were evaluated including new-onset hormone deficiency, tumor recurrence, and new neurological complications.
The study cohort comprised 289 patients. The endocrine remission rates were 28%, 41%, and 54% at 3, 5, and 8 years after SRS, respectively. Following SRS, 25% of patients (72/289) had new hormone deficiency. Sixty-three percent of the patients (127/201) with available data attained endocrine control. Three percent of patients (9/269) had a new visual complication after SRS. Five percent of the patients (13/285) were recorded as having tumor progression. A pretreatment PRL level ≤ 270 ng/ml was a predictor of endocrine remission (p = 0.005, adjusted HR 0.487). An increasing margin dose resulted in better endocrine control after SRS (p = 0.033, adjusted OR 1.087).
In patients with medically refractory prolactinomas or a residual/recurrent prolactinoma, SRS affords remarkable therapeutic effects in endocrine remission, endocrine control, and tumor control. New-onset hypopituitarism is the most common adverse event.
ABBREVIATIONSACTH = adrenocorticotropic hormone; EBRT = external beam radiotherapy; GH = growth hormone; IRRF = International Radiosurgery Research Foundation; PRL = prolactin; SRS = stereotactic radiosurgery; TSH = thyroxine-stimulating hormone.
Correspondence Jason Sheehan: University of Virginia, Charlottesville, VA. email@example.com.
INCLUDE WHEN CITING Published online August 2, 2019; DOI: 10.3171/2019.4.JNS183443.
Disclosures Dr. Grills owns stock in and serves on the board of directors for Greater Michigan Gamma Knife and receives funding from Elekta through her institution for non–study-related research. Dr. Lunsford owns stock in Elekta AB and is a consultant for Insightec, DSMB. Dr. Liscak is a consultant for Elekta AB. Dr. Zacharia is a consultant for Medtronic Inc. and serves on the Speakers Bureau for NICO Corp.
ColaoA, Di SarnoA, CappabiancaP, Di SommaC, PivonelloR, LombardiG: Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. 349:2023–2033, 20031462778710.1056/NEJMoa022657)| false
DelgrangeE, DaemsT, VerhelstJ, AbsR, MaiterD: Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients. 160:747–752, 20091922345410.1530/EJE-09-0012)| false
Di SarnoALandiMLCappabiancaPDi SalleFRossiFWPivonelloR: Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: prevalence, clinical definition, and therapeutic strategy. J Clin Endocrinol Metab86:5256–52612001
Di SarnoA, LandiML, CappabiancaP, Di SalleF, RossiFW, PivonelloR, : Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: prevalence, clinical definition, and therapeutic strategy. 86:5256–5261, 200110.1210/jcem.86.11.8054)| false
dos Santos NunesVEl DibRBoguszewskiCLNogueiraCR: Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and meta-analysis. Pituitary14:259–2652011
dos Santos NunesV, El DibR, BoguszewskiCL, NogueiraCR: Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and meta-analysis. 14:259–265, 201110.1007/s11102-010-0290-z)| false
KongDSLeeJILimDHKimKWShinHJNamDH: The efficacy of fractionated radiotherapy and stereotactic radiosurgery for pituitary adenomas: long-term results of 125 consecutive patients treated in a single institution. Cancer110:854–8602007
KongDS, LeeJI, LimDH, KimKW, ShinHJ, NamDH, : The efficacy of fractionated radiotherapy and stereotactic radiosurgery for pituitary adenomas: long-term results of 125 consecutive patients treated in a single institution. 110:854–860, 200710.1002/cncr.22860)| false
MelmedS, CasanuevaFF, HoffmanAR, KleinbergDL, MontoriVM, SchlechteJA, : Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. 96:273–288, 20112129699110.1210/jc.2010-1692)| false
PollockBE, BrownPD, NippoldtTB, YoungWFJr: Pituitary tumor type affects the chance of biochemical remission after radiosurgery of hormone-secreting pituitary adenomas. 62:1271–1278, 200810.1227/01.neu.0000333298.49436.0e18824993)| false
PollockBENippoldtTBStaffordSLFooteRLAbboudCF: Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg97:525–5302002
RoelfsemaF, BiermaszNR, PereiraAM: Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. 15:71–83, 20122191883010.1007/s11102-011-0347-7)| false
SheehanJP, PouratianN, SteinerL, LawsER, VanceML: Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes. 114:303–309, 20112054059610.3171/2010.5.JNS091635)| false
VerhelstJ, AbsR, MaiterD, van den BruelA, VandewegheM, VelkeniersB, : Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. 84:2518–2522, 19991040483010.1210/jcem.84.7.5810)| false
VroonenL, Jaffrain-ReaML, PetrossiansP, TamagnoG, ChansonP, VilarL, : Prolactinomas resistant to standard doses of cabergoline: a multicenter study of 92 patients. 167:651–662, 20122291830110.1530/EJE-12-0236)| false
WilsonPJWilliamsJRSmeeRI: Single-centre experience of stereotactic radiosurgery and fractionated stereotactic radiotherapy for prolactinomas with the linear accelerator. J Med Imaging Radiat Oncol59:371–3782015
WilsonPJ, WilliamsJR, SmeeRI: Single-centre experience of stereotactic radiosurgery and fractionated stereotactic radiotherapy for prolactinomas with the linear accelerator. 59:371–378, 201510.1111/1754-9485.1225725410143)| false