Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas.
OBJECTIVE
To describe the technique and results of stereotactically guided conformal radiotherapy (SCRT) in patients with craniopharyngioma after conservative surgery.


METHODS
Thirty-nine patients with craniopharyngioma aged 3-68 years (median age 18 years) were treated with SCRT between June 1994 and January 2003. All patients were referred for radiotherapy after undergoing one or more surgical procedures. Treatment was delivered in 30-33 daily fractions over 6-6.5 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively.


RESULTS
At a median follow-up of 40 months (range 3-88 months) the 3- and 5-year progression-free survival (PFS) was 97% and 92%, and 3- and 5-year survival 100%. Two patients required further debulking surgery for progressive disease 8 and 41 months after radiotherapy. Twelve patients (30%) had acute clinical deterioration due to cystic enlargement of craniopharyngioma following SCRT and required cyst aspiration. One patient with severe visual impairment prior to radiotherapy had visual deterioration following SCRT. Seven out of 10 patients with a normal pituitary function before SCRT had no endocrine deficits following treatment.


CONCLUSIONS
SCRT as a high-precision technique of localized RT is suitable for the treatment of incompletely excised craniopharyngioma. The local control, toxicity and survival outcomes are comparable to results reported following conventional external beam RT. Longer follow-up is required to assess long-term efficacy and toxicity, particularly in terms of potential reduction in treatment related late toxicity.
Minniti
Giuseppe
G
Neuro-oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
Saran
Frank
F
Traish
Daphne
D
Soomal
Rubin
R
Sardell
Susan
S
Gonsalves
Adam
A
Ashley
Susan
S
Warrington
Jim
J
Burke
Kevin
K
Mosleh-Shirazi
Amin
A
Brada
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007031:Hypothalamus / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000528:radiation effects; D010911:Pituitary Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014785:Vision, Ocular / Q000528:radiation effects