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Greenman et al. (36) addressed the issue of DA administration for patients with NFPA in a larger cohort. They assessed outcomes of 33 post-surgical patients: 20 with remnant tumors, treated preventively (group I); 13 with tumor growth during follow-up (group II). All the patients were initially treated with bromocriptine (mean dose 8 0.7 mg/day), but 10 subjects were switched to quinagolide (up to 300 mg/day) or cabergoline (up to 1.5 mg/week) due to side effects. The control group consisted of 47 patients who only underwent surgery. The actuarial tumor growth-free survival rates at 2 years were 94 and 50% in treatment groups I and II, respectively. For the control group, the actuarial tumor growth-free survival rates at 2 and 5 years were 65 and 17%, respectively. Although this study apparently indicates the efficacy of DA in the management of post-surgical tumor growth in patients harboring NFPA, certain flaws may compromise its interpretation and validation. For one, although the authors considered the treated and control groups as matched, the patients were treated in different departments; the Ki-67 expression was not cited, and the degree of cavernous sinus invasion was not detailed. Secondly, the type and dose of the DA drugs administered were characterized by considerable heterogenicity. Thirdly, the actuarial tumor growth-free survival in the DA groups referred to only 2 years of follow-up. Fourthly, differences between the control group and treatment group II were not significant, therefore, the distinctive tumor behavior in the two treatment groups could explain the different outcomes. Last, but not least, D2R expression in the tumors was not assessed.

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