| Objective:To investigate the effect of gamma knife radiosurgery for pituitary prolactinoma and to analyze the related factors that affect the efficacy.Methods:The 135 cases clinical dates of pituitary prolactinoma which collected from three different gamma knife research centers were retrospectively analyzed the effects and complications.54 patients were treated by surgery before Gamma Knife treatment.81 patients were treated by gamma knife first time.Before the operation of gamma knife, pituitary hormone and MRI have been checked and tried to rule out other causes of elevated prolactin causes and diseases. 50% isodose curve enveloping the target, given marginal dose 14～30Gy, for a huge adenoma using fractionated treatment, the efficacy was evaluate by the postoperative hormone levels and clinical symptoms.After the operation of gamma knife,periodic review of PRL and MRI were checked. We analysis statistically the ralationships between the effect of gamma knife treatment and 7 factors,including,surgery,dopamine agonists(Dopamine Agonists, DA),peripheral dose,tumor volume,preoperative PRL level,gender.Results:1 follow-up results All patients were followed up for 6 to 21 months,average follow-up (14.58±2.42) months, The level of PRL returned to normal for the 44 cases, the cure rate was 32.6%; The level of PRL decreased in 56 cases (59.4%).The total effective rate was 74.1%. Gamma Knife treatment inhibited tumor growth.Effective control-rate was 71.9%;7 cases (5.2%) had hypopituitarism.2 Analysis of prognostic factors Before Gamma Knife Treatment,The levels of PRL are 100~1009μg/L. 6 variables were analysised on univariate (chi-square test).The result showed that the level of post-gamma knife PRL were associated with invasive pituitary prolactinoma (χ~2=4.426,P=0.039), the history of surgery (χ~2=5.114,P=0.042), the history of taking DA (χ~2=9.244,P=0.002), marginal dose (χ~2=13.431,P=0.002), tumor size (χ~2=6.927,P=0.019), preoperative levels of PRL (χ~2=8.535,P=0.003), and not associated with gender (χ~2=1.985,P=0.159); whether there is invasion, tumor size, Marginal dose of gamma knife treatment of pituitary prolactinoma were independent predictors of effects of gamma knife treatment by multivariate analysis of Logistic.Conclusion:1 Gamma Knife treatment of PRL adenoma is a safe and effective treatment;2 The PRL levels of Post-gamma knife were associated with the invasive PRL adenoma,the surgery, the history taking of DA,marginal dose, tumor size, preoperative levels of PRL,and not associated with gender.3Invasive pituitary prolactinoma, tumor size, margin dose was significant prognostic factors; Surgery,the history taking of DA, PRL levels before gamma knife treatment does not significantly correlated with the prognosis. |
