Gamma Knife Surgery For Prolactinomas: Long-term Out Come Of 120 Cases

Wei Wang1, Peng Li2, Xing Wang1

1West China Hospital, Chengdu, China 2Chengdu, China

Keywords: prolactinoma, pituitary adenoma, gamma knife, outcome, hormone dysfunction

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     In this retrospective review, we evaluated the long-term efficacy of gamma knife surgery (GKS) for pituitary prolactinomas on tumor control and reduction of serum prolactin. And the safety of the therapy was also evaluated.
      From January 2005 to December 2007, 120 patients of pituitary prolactinoma underwent GKS at West China Hospital. Of these, 30 patients had previous resection by trans-sphenoidal or craniotomy approach. None of the patients had previous external beam radiation therapy.
     The endocrine information and the tumor size were obtained before the treatment as the baseline. The prescription dose and isodose line were 12-32Gy and 50-75%. And the plug pattern was used to limit the dose to the optical apparatus to be under 8Gy if necessary. Serial MRIs and serum prolactin level check were scheduled every six months after the treatment. The tumor control was defined as no further growth. Back to normal or more than 50% reduction of the serum prolactin was defined as effective and the efficacy at six, twelve and eighteen months after the treatment were compared. Also the side effects of these treatments were analyzed.
     The mean follow-up for the whole cohort was 37.4 months (range:18-54 months). Tumor control was 97.5 % (117/120). One patient showed successful tumor control but progressed to pituitary apoplexy 14 months after GKS and had surgery resection. The endocrine improvements at six, twelve and eighteen months were 45.8 % (55), 57.5 % (69) and 65.8 % (79). The differences of the efficacy were statistically significant. Two patients with tumor compression on optical apparatus and the patient with pituitary apoplexy presented visual dysfunction. Hypopituitarism happened in two patients who both had received previous surgeries. None of the patients developed other cranial nerve dysfunction. And no mortality happened in this study.
     This is a retrospective study.
     The result supports the safety and efficacy of GKS for prolactinomas.
     GKS may provide an excellent tumor control rate and satisfactory endocrine improvement. And it is suggested that a long-term follow up be scheduled because of the slow reduction of prolactin.


Project Roles:

W. Wang (), P. Li (), X. Wang ()