Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist

Moon Sool Yang, Jae Won Hong, Seung Koo Lee, Eunjig Lee, Sun Ho Kim

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome. Herein, we document the results of bromocriptine administration as initial treatment during average 44 months follow-up (up to 12 years) period. We retrospectively categorized 36 patients into four groups according to the results of 3 months of bromocriptine treatment: group 1, tumor volume reduction (TVR) >25% with normalized serum prolactin (NP) (n = 24); group 2, TVR >25% without NP (n = 4); group 3, TVR <25% with NP (n = 5); and group 4, TVR <25% without NP (n = 3). During follow-up, 22 patients (91.7%) in group 1 achieved TVR >50% with NP. Three patients (75%) in group 2 achieved TVR >50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR (18.8-46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and all three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with bromocriptine had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%, with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor. Patients who achieve TVR >25% with NP with 3 months of bromocriptine administration had a high possibility of showing good long-term response (TVR >50% with NP) to bromocriptine. A higher dose of dopamine agonist (DA) or other DA should be considered for patients who achieve TVR >25% without NP.

Original languageEnglish
Pages (from-to)195-204
Number of pages10
JournalJournal of Neuro-Oncology
Volume104
Issue number1
DOIs
Publication statusPublished - 2011 Aug 1

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Prolactinoma
Dopamine Agonists
Tumor Burden
Prolactin
Bromocriptine
Serum
Cavernous Sinus
Therapeutics
Adenoma

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology

Cite this

Yang, Moon Sool ; Hong, Jae Won ; Lee, Seung Koo ; Lee, Eunjig ; Kim, Sun Ho. / Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist. In: Journal of Neuro-Oncology. 2011 ; Vol. 104, No. 1. pp. 195-204.
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abstract = "Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome. Herein, we document the results of bromocriptine administration as initial treatment during average 44 months follow-up (up to 12 years) period. We retrospectively categorized 36 patients into four groups according to the results of 3 months of bromocriptine treatment: group 1, tumor volume reduction (TVR) >25{\%} with normalized serum prolactin (NP) (n = 24); group 2, TVR >25{\%} without NP (n = 4); group 3, TVR <25{\%} with NP (n = 5); and group 4, TVR <25{\%} without NP (n = 3). During follow-up, 22 patients (91.7{\%}) in group 1 achieved TVR >50{\%} with NP. Three patients (75{\%}) in group 2 achieved TVR >50{\%} with NP after treatment for 8 months. In group 3, four patients (80.0{\%}) continued medication because of improvement of symptoms and achieved additional TVR (18.8-46.4{\%}). Surgery was performed on five patients (one in group 2, one in group 3, and all three in group 4), and complete resection was achieved in four (80.0{\%}). Overall, 25 (69.4{\%}) of the 36 patients treated with bromocriptine had complete response and 6 (16.7{\%}) had partial response but did not require surgery. Thus, the overall response rate was 86{\%}, with only five patients (14{\%}) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor. Patients who achieve TVR >25{\%} with NP with 3 months of bromocriptine administration had a high possibility of showing good long-term response (TVR >50{\%} with NP) to bromocriptine. A higher dose of dopamine agonist (DA) or other DA should be considered for patients who achieve TVR >25{\%} without NP.",
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Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist. / Yang, Moon Sool; Hong, Jae Won; Lee, Seung Koo; Lee, Eunjig; Kim, Sun Ho.

In: Journal of Neuro-Oncology, Vol. 104, No. 1, 01.08.2011, p. 195-204.

Research output: Contribution to journalArticle

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