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      The benefit and risk of stereotactic radiosurgery for prolactinomas: an international multicenter cohort study

      1 , 2 , 3 , 4 , 5 , 4 , 1 , 1 , 6 , 7 , 6 , 7 , 6 , 7 , 6 , 7 , 6 , 7 , 6 , 7 , 8 , 9 , 10 , 10 , 10 , 11 , 11 , 12 , 12 , 13 , 13 , 14 , 14 , 14 , 15 , 15 , 1 , 1
      Journal of Neurosurgery
      Journal of Neurosurgery Publishing Group (JNSPG)

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          Abstract

          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.

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          Author and article information

          Journal
          Journal of Neurosurgery
          Journal of Neurosurgery Publishing Group (JNSPG)
          0022-3085
          1933-0693
          August 2019
          August 2019
          : 1-10
          Affiliations
          [1 ]1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;
          [2 ]2Departments of Neurosurgery and Surgery, Chi-Mei Medical Center, Tainan;
          [3 ]3Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan;
          [4 ]4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
          [5 ]5School of Medicine, National Yang-Ming University, Taipei, Taiwan;
          [6 ]6Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo;
          [7 ]7Department of Neurosurgery, Benha University, Qalubya, Egypt;
          [8 ]8Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague;
          [9 ]9Department of Endocrinology and Metabolism, 3rd Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic;
          [10 ]10Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;
          [11 ]11Radiosurgery Unit, Hospital Ruber Internacional, Madrid, Spain;
          [12 ]12Department of Neurosurgery, NYU Langone Health System, New York, New York;
          [13 ]13Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan;
          [14 ]14Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; and
          [15 ]15Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
          Article
          10.3171/2019.4.JNS183443
          31374549
          9a8424d4-046a-4190-825a-66c347361873
          © 2019
          History

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