TY - JOUR
T1 - The benefit and risk of stereotactic radiosurgery for prolactinomas
T2 - an international multicenter cohort study
AU - Hung, Yi Chieh
AU - Lee, Cheng Chia
AU - Yang, Huai Che
AU - Mohammed, Nasser
AU - Kearns, Kathryn N.
AU - Nabeel, Ahmed M.
AU - Karim, Khaled Abdel
AU - Emad Eldin, Reem M.
AU - El-Shehaby, Amr M.N.
AU - Reda, Wael A.
AU - Tawadros, Sameh R.
AU - Liscak, Roman
AU - Jezkova, Jana
AU - Lunsford, L. Dade
AU - Kano, Hideyuki
AU - Sisterson, Nathaniel D.
AU - Álvarez, Roberto Martínez
AU - Martínez Moreno, Nuria E.
AU - Kondziolka, Douglas
AU - Golfinos, John G.
AU - Grills, Inga
AU - Thompson, Andrew
AU - Borghei-Razavi, Hamid
AU - Maiti, Tanmoy Kumar
AU - Barnett, Gene H.
AU - McInerney, James
AU - Zacharia, Brad E.
AU - Xu, Zhiyuan
AU - Sheehan, Jason P.
N1 - Publisher Copyright:
©AANS 2020.
PY - 2020/9
Y1 - 2020/9
N2 - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
AB - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
UR - http://www.scopus.com/inward/record.url?scp=85090231844&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090231844&partnerID=8YFLogxK
U2 - 10.3171/2019.4.JNS183443
DO - 10.3171/2019.4.JNS183443
M3 - Article
C2 - 31374549
AN - SCOPUS:85090231844
SN - 0022-3085
VL - 133
SP - 717
EP - 726
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 3
ER -