Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation.
OBJECTIVE
The efficacy of stereotactic intracavitary irradiation with phosphorus-32 ((32)P) for patients with cystic craniopharyngiomas was assessed on the basis of patient survival, tumor control, and visual and endocrinological function before and after treatment. Limited data are available regarding long-term outcomes.


METHODS
Forty-nine patients were treated with stereotactic (32)P intracavitary irradiation. Of these, 25 had had no prior treatment as the primary treatment, and 24 were treated for residual or recurrent tumor cysts. At the time of (32)P intracavitary irradiation, 34 of the patients were adults, and 15 were children younger than 16 years of age. The mean cyst volume was 13 ml. The radiation dose varied from 189 to 250 Gy to the cyst wall during five half-lives of the isotope (mean, 224 Gy). The mean follow-up periods were 7 years after diagnosis and 4 years after (32)P treatment.


RESULTS
The actuarial survival rates were 90% at 5 years after the diagnosis and 80% at 10 years. The actuarial tumor cyst control rates were 76% at 5 years and 70% at 10 years after the diagnosis. After treatment, 9 (23%) of 40 patients who underwent preoperative and postoperative visual testing were found to have delayed worsening in visual function, 6 as a result of tumor progression and 3 attributed to irradiation. Nineteen patients (48%) had improved visual function. Of 17 patients who had normal preoperative pituitary function or stalk effect, 12 (71%) had preserved and 5 (29%) had worsened visual function. No complications other than visual or endocrinological deterioration occurred in these patients.


CONCLUSIONS
For patients with cystic craniopharyngiomas, (32)P intracavitary irradiation proved effective, with a low risk of complications, for the control of tumor cysts but not of solid tumor components.
Hasegawa
Toshinori
T
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Kondziolka
Douglas
D
Hadjipanayis
Costas G
CG
Lunsford
L Dade
LD
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003560:Cysts / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D013238:Stereotaxic Techniques; D015996:Survival Rate
D010761:Phosphorus Radioisotopes