Long-term results of radiotherapy for prolactin-secreting pituitary macroadenomas

✍ Scribed by Shari B. Rudoler; James E. Ruffer; Thomas A. Gennarelli; Peter J. Savino; Barbara F. Fowble

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 598 KB
• Volume: 4
• Category: Article
• ISSN: 1065-7541
• DOI: 10.1002/(sici)1520-6823(1996)4:4<185::aid-roi6>3.0.co;2-u

✦ Synopsis

Long-term follow-up experience treating prolactin-secreting macroadenomas with radiotherapy (RT) alone or in combination with surgery and/or bromocriptine is reported. Between January 1972 and January 1995,28 patients received external beam RT as primary management (n = 5 ) for prolactin-secreting macroadenomas or for residual (n = 18) or recurrent (n = 5 ) disease after surgery. The median age at diagnosis was 38 years (range, 15-75). AU patients except one were evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Visual symptoms were present in 71 %; amenorrhea was present in 75% of premenopausal women, galactorrhea in 5 women, impotency in 7 men, and gynecomastia in 6 men. Median pre-RT prolactin level was 572 ng/ml (range, 2643,300). Twelve patients were treated with dopamine agonists during the course of their treatment. Median RT dose was 46 Gy (range, 44.8-50) in 1.8-2-Gy daily fractions. Median follow-up in 28 patients was 140 months (range, 3-275). The 10-and 15-year actuarial freedom from recurrence rates are 95% and 71% respectively, and the 10-and 15-year cause-specific survival rates are 95%. RT contributed to new or worsened endocrinopathy in 52% of the patients. Visual improvement or stabilization was observed in 87% (2 1 of 24) and prolactin levels normalized or decreased to less than 85% of the pretreatment value in 87%. Follow-up CT/MRI showed no residual in ten patients, improved or stable disease in ten patients, and progression in one patient. There were no instances of radiation necrosis or ophthamologic complications. RT alone or in combination with surgery and/ or dopamine agonists is a safe and effective treatment modality for residual or recurrent prolactin-secreting macroadenomas.