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

Objective: Prolactinomas, the most common pituitary adenoma, 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 this systematic review and meta-analysis.

Method: A literature search was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guideline for studies that reported outcomes for SRS in DA resistant and/or DA intolerant prolactinomas that may or may not underwent surgery during the span of 2006 to 2021. The following outcomes were reported by studies: endocrine/hormonal outcomes, radiologic outcomes and adverse outcomes.

Results: A total of 11 articles (total N = 709) met inclusion criteria. 33% of patients were able achieve endocrine remission (p < 0.01, I ² = 76.10%) 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 (p < 0.01, I ² = 89.32%) with DA therapy post SRS and 34% of patients were able to reduce the dose of DA dose when compare with pre-SRS DA dose (p < 0.01, I ² = 70.66%)at the end of the follow-up period. However, 54% of patients require DA (p < 0.01, I ² = 78.46%) at the end of the follow-up to control hyperprolactinemia. 64% of patients were able to achieve radiologic regression (p < 0.01, I ² = 90.66%) as well as 26% of patients achieved radiologic stability (p < 0.01, I ² = 83.36%) at the end of the follow-up in comparison with pre-SRS imagings. Furthermore, 26% of patients experienced newly developed hypopituitarism (one or more pituitary hormone) post-SRS throughout (p < 0.01, I ² = 94.49%) 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% of patients achieving endocrine remission, 62% achieving hormonal control with DA following GKS, 34% reduction of DA dose and 64% achieving radiologic regression.

Publication History

Article published online:
15 February 2022