GAMMA KNIFE RADIOSURGERY FOR INVASIVE PROLACTINOMAS

Xiaomin Liu, MD, PhD1, Hideyuki Kano, MD, PhD2, Douglas Kondziolka, MSc, MD2, Kyung-Jae Park3, Aditya K Iyer, BS, MSc4, Samuel Shin5, Ajay Niranjan, MCh2, John C. Flickinger, MD6, L. Dade Lunsford3

1Department of Neurosurgery and Gamma Knife Center, 2ND Hospital of Tianjin Medical University 2Department of Neurological Surgery, University of Pittsburgh 3Department of Neurological Surgery , University of Pittsburgh Medical Center 4University of Pittsburgh 5University of Pittsburgh School of Medicine 6Department of Radiation Oncology, University of Pittsburgh

Keywords: outcome, radiosurgery, gamma knife, prolactinoma, pituitary adenoma

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Abstract

     Pituitary tumors are suitable for radiosurgery but prolactinoma outcomes are uncommonly reported.
     We evaluated the efficacy of Gamma knife radiosurgery (GKRS) as an adjunctive management modality for patients with cavernous sinus invasive prolactinomas.
     Twenty-two patients with cavernous sinus invasive prolactinoma underwent GKRS between 1994 and 2009. Thirteen patients were dopamine agonist (DA) resistant. Six patients were intolerant to DA. One patient took GKRS as primary treatment modality by his own choice. Two patients chose GKRS as a treatment modality hoping to avoid life long medication use. The median tumor volume was 3.0 cm3 (range 0.3-11.6) .
      A median dose of 15 Gy was prescribed to the tumor margin (range 12-25). The median follow-up interval was 36 months (range, 12-185). Endocrine normalization was defined as a normal serum prolactin level off DA (cure) or on DA. Endocrine improvement was defined as decreased serum prolactin level but still abnormal. Endocrine deterioration was defined as increased serum prolactin level.
     Endocrine normalization was achieved in six (27.3%) patients. Thirteen (54.5%) patients had endocrine improvement. Four patients got endocrine deterioration. Imaging-defined local tumor control was achieved in 19 (86.4%) patients (12 had tumor regression). Three patients had tumor recurrence and underwent further treatment. One patient developed a new pituitary axis deficiency after GKRS.
     This was a retrospective study.
     Invasive prolactinomas remain a clinical challenge. 
     GKRS is a less invasive adjunctive management option and is effective in controlling prolactin levels in selected patients.


Acknowledgements

Project Roles:

X. Liu (), H. Kano (), D. Kondziolka (), K. Park (), A. Iyer (), S. Shin (), A. Niranjan (), J. Flickinger (), L. Lunsford ()