This protocol addresses prolactinoma in patients who have already undergone transsphenoidal surgical resection or debulking by an experienced neurosurgeon, yet have not achieved normoprolactinaemia — serum prolactin levels remain above normal following surgery.
Prior therapy: Transsphenoidal surgery (surgical resection / debulking) by an experienced neurosurgeon.
Goal that was not met: Initial normoprolactinaemia — normalization of serum prolactin levels.
Failure to achieve this target is the trigger for escalation to the current treatment line.
Management at this stage involves a radiation-based intervention employing stereotactic techniques. The specific clinical criteria, sequencing, and full structured regimen are set out in the complete protocol.
Dosing, scheduling, and the complete decision framework are available via the link below.
DOI: 10.1038/s41574-023-00886-5
Radiation therapy should be reserved for patients who show poor mass shrinkage in response to dopamine agonists and have either non-resectable residual adenoma tissue after surgery or contraindications for surgery (strong).
Stereotactic radiotherapy techniques yield improved outcomes and have now become standard of care where available (strong).
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