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Radiotherapy in aggressive or dopamine agonists resistant prolactinomas; is it still worthwhile?
Dan Alexandru Niculescu1,2, Monica Livia Gheorghiu1,3, Catalina Poiana1,2
1Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
European Journal of Endocrinology
|March 28, 2023
Summary
Radiotherapy effectively controls aggressive prolactinomas resistant to dopamine agonists (DA) or surgery. While side effects like hypopituitarism exist, it offers a viable option for challenging cases.
Area of Science:
- Endocrinology
- Radiation Oncology
Background:
- Prolactinomas are pituitary tumors managed with dopamine agonists (DA), surgery, or radiotherapy.
- Radiotherapy is typically reserved for aggressive, resistant, or recurrent cases due to potential side effects.
Approach:
- This review synthesizes published literature on radiotherapy (conventional fractionated or radiosurgery) for prolactinomas.
- Focus is on efficacy and toxicity in aggressive, high-risk, or DA-resistant prolactinomas.
Key Points:
- Radiotherapy demonstrates significant efficacy in tumor control (68-100%) and hormonal control (>50% globally, 28-100% in resistant cases).
- The 5-year incidence of hypopituitarism is approximately 12-25%.
- Evidence for prophylactic radiotherapy in aggressive markers is limited, requiring individualized decisions.
Conclusions:
- Radiotherapy is a valuable treatment for growing, aggressive, or dopamine agonist-resistant prolactinomas.
- Its use in high-risk or invasive prolactinomas should be individualized.
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