Stereotactic Radiosurgery Outcomes in Medically and Surgically Failed or Non-Surgical Candidates with Medically Failed Prolactinomas: A Systematic Review and Meta-analysis

Karan J. Yagnik, Dana Erickson, Irina Bancos, Garret Choby, Nadia Laack, Jamie Van Gompel

Research output: Contribution to journalArticlepeer-review

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 non-surgical candidates with medically failed prolactinomas by systematic review and meta-analysis. Method: A literature search was conducted according to the PRISMA guideline. Results: A total of 11 articles (Total N=709) met inclusion criteria. 33% 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. 62% 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 compare to pre-SRS DA dose at the end of the follow-up period. However, 54% of patients require DA at the end of the follow-up to control hyperprolactinemia. 90% 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 non-surgical candidates or surgically and medically recalcitrant prolactinomas with a 33% chance of achieving endocrine remission, 62% of patients achieve hormonal control with DA and GKS, with 34% chances of decreasing DA dose and 90% chances of achieving radiologic control.

Original languageEnglish (US)
JournalJournal of Neurological Surgery, Part B: Skull Base
DOIs
StateAccepted/In press - 2022

Keywords

  • Cavernous Sinus Invasion
  • Dopamine Intolerance
  • Dopamine Resistance
  • Gamma Knife
  • peri-SRS DA stop
  • Prolactinoma
  • SRS
  • Stereotactic Radiosurgery
  • Surgically failed prolactinoma

ASJC Scopus subject areas

  • Clinical Neurology

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