Use of the Leksell gamma knife in the treatment of prolactinoma patients.
OBJECTIVE
Pharmacological treatment with dopaminergic agonists (DA) is the treatment of choice for prolactinomas. Surgical and radiation treatment is also indicated in certain situations. We describe our 12-year experience in treating prolactinomas with the Leksell gamma knife (LGK).


METHODS
We followed 35 prolactinoma patients (25.7% microprolactinomas, 74.3% macroprolactinomas) treated with LGK irradiation. The mean follow-up period was 75.5 months. Prior to LGK irradiation, patients were treated with DA and 10 of them (28.6%) underwent neurosurgery. Indications for LGK irradiation were: DA intolerance (31.4%), DA resistance (45.7%) and efforts to reduce the DA dose or shorten the period of administration (22.9%). Pituitary function was monitored regularly at 6-month intervals. The central radiation dose range was 40-80 Gy (median 70 Gy), and the minimal peripheral dose was 20-49 Gy (median 34 Gy).


RESULTS
Normoprolactinaemia was achieved in 37.1% of the patients who discontinued DA and in 42.9% of patients who continued DA treatment after LGK irradiation. The median time to prolactin normalization after discontinuation of DA was 96 months. No relapse was seen in any patient. After LGK irradiation, the prolactinoma stopped growing or decreased in size in all but one patient (97.1%).


CONCLUSIONS
LGK treatment resulted in normoprolactinaemia in 80.0% of the patients, all of whom had failed pharmacological treatment due to DA resistance or intolerance. After achieving normoprolactinaemia, no relapse of hyperprolactinaemia was observed in any patient. The size of the adenoma decreased even in those patients in whom it was not changed by previous DA treatment.
Jezková
Jana
J
Third Department of Medicine, First Medical Faculty, Charles University, Prague, Czech Republic. fjjezek@cmail.cz
Hána
Václav
V
Krsek
Michal
M
Weiss
Vladimír
V
Vladyka
Vilibald
V
Liscák
Roman
R
Vymazal
Josef
J
Pecen
Ladislav
L
Marek
Josef
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
D018491:Dopamine Agonists; D011388:Prolactin