Prolactin secreting pituitary adenomas: Analysis of 429 surgically treatedpatients, effect of adjuvant treatment modalities and review of the literature

Objective. We performed this retrospective analysis to determine the effica cy of surgery and radiotherapy over hormonal and volumetric control of prol actinomas, many of which had failed during dopa-agonist therapy. In the sam e analysis. the efficiency of topical bromocriptine application as a prelim inary study was compared with standard treatment modalities. Materials and Methods. Between 1982-1997. 429 prolactinoma patients who und erwent surgery at Hacettepe University Neurosurgery Department and at Bayin dir Medical Center were included in this study. All patients were classifie d according to Hardys classification scheme and were Further divided into ' invasive' and 'noninvasive' groups based on this radiological classificatio n system. The mean Follow-up rime was 38.4 months. One hundred and thirty f ive patients had peroperative bromocriptine application into the sellar cav ity(1) and these, either receiving radiotherapy (RT) or not, were analysed separately from the other 294 patients. In the early postoperative period, 104 of these patients were given conventional radiotherapy with median dose of 4500 cGy. We focused on the effects of surgery and radiotherapy over vo lumetric and hormonal tumour control on the basis of invasion characteristi cs and the early results of topical bromocriptine application in macroprola ctinoma patients: and compared our results with the literature. Results. Statistical analysis revealed that radiotherapy was not effective over hormonal and volumetric tumour control for prolactinomas. We did not o bserve any correlation to dural invasion of the sellar floor, recurrence. a nd the disease-free survival time. Topical bromocriptine application seemed to improve the volumetric control in 135 selected macroprolactinoma patien ts bur not hormonal response compared with the standard treatment modalitie s. Conclusion. Conventional radiotherapy is nor as effective as expected for p rolactinomas and should not be preferred considering its adverse effects. T umoural infiltration of the sellar dura mater is not a prognostic criterion for recurrence expectation and, therefore, should not be a criterion for r adiotherapy after surgery. After subtotal removal. postoperative dopa-agoni st therapy should be considered even if the patient was intolerant or resis tant to previous treatment since surgery seems to improve patients' drug to lerance and cooperation due probably to the lower dose requirement. The ear ly results of topical bromocriptine application seem to improve volumetric tumour control but this should nor he accepted as a judgement since we need to wait for later results and to expand the sample size for more reliable interpretation.