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J Neurol Surg B Skull Base 2023; 84(06): 538-547
DOI: 10.1055/a-1934-9028
Original Article

Stereotactic Radiosurgery Outcomes in Medically and Surgically Failed or Nonsurgical Candidates with Medically Failed Prolactinomas: A Systematic Review and Meta-Analysis

Karan J. Yagnik 
1   Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Dana Erickson
2   Department of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, United States
,
Irina Bancos
2   Department of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, United States
,
Garret Choby
3   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Nadia Laack
4   Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States
,
Jamie J. Van Gompel 
1   Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Objective Prolactinomas are treated with dopamine agonists (DAs) as first-line therapy and transsphenoidal surgery as an alternative approach for medically failed tumors. We sought to summarize the efficacy of stereotactic radiosurgery (SRS) in the medically and surgically failed prolactinomas as well as in nonsurgical candidates with medically failed prolactinomas by systematic review and meta-analysis.

Method A literature search was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline.

Results A total of 11 articles (total N = 709) met inclusion criteria. Thirty-three percent of patients were able to achieve endocrine remission at a mean follow-up of 54.2 ± 42.2 months with no association between stopping DA and endocrine remission. Sixty-two percent of patients were able to achieve endocrine control with DA therapy and 34% of patients were able to decrease the dose of DA dose when compared with pre-SRS DA dose at the end of the follow-up period. However, 54% of patients required DA at the end of the follow-up to control hyperprolactinemia. Ninety percent of patients were able to achieve radiologic control at the end of the follow-up in comparison to pre-SRS imagings. Furthermore, 26% of patients newly developed hypopituitarism (one or more pituitary hormones) post-SRS throughout the follow-up period.

Conclusion This systematic review and meta-analysis demonstrates SRS as an effective adjunct therapy in medically failed nonsurgical candidates or surgically and medically recalcitrant prolactinomas with a 33% chance of achieving endocrine remission, 62% of patients achieved hormonal control with DA and GKRS (gamma knife radio-surgery), with a 34% chance of decreasing DA dose and 90% chance of achieving radiologic control.

Keywords

stereotactic radiosurgery - prolactinoma - gamma knife - surgically failed prolactinoma - dopamine resistance - dopamine intolerance - cavernous sinus invasion - SRS - peri-SRS DA stop

Authors' Contributions

• K.J.Y.: Conception and study design, data collection, data analysis, writing an original draft.

• D.E.: Conception and study design, critically revising draft.

• I.B.: Conception and study design, critically revising draft.

• G.C.: Conception and study design, critically revising draft.

• N.L.: Conception and study design, critically revising draft.

• J.V.G.: Study supervision, conception and study design, critically revising draft, approving final version of draft.


Previous Publication

Abstract of this article has been accepted as the podium presentation at the North American Skull Base Society (NASBS) -2022 annual meeting at Phoenix, AZ in February 18–22, 2022.


Availability to Data and Materials

All available data and materials are included in texts, tables, figures, supplements, and references.


Supplementary Material



Publication History

Received: 20 April 2022

Accepted: 29 August 2022

Accepted Manuscript online:
31 August 2022

Article published online:
23 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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