Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas.
OBJECTIVE
Data were analyzed to assess the value of stereotactically applied intracystic colloidal yttrium-90 (YTx) for the treatment of recurrent cystic craniopharyngiomas during a 30-year period.


METHODS
This article compares data from 73 YTx procedures in 60 patients between 1975 and 2006. The cumulative beta dose aimed at the inner surface of the cyst wall was 300 Gy.


RESULTS
After YTx, the initial cyst volumes decreased an average of 79%. In 47, the reduction was more than 80%; in 27 of them, the cyst disappeared completely within 1 year. The mean survival after YTx was 9.4 years (range, 0.7-30 yr). Actuarial survival rates at 5, 10, 15, 20, 25, and 30 years were 81, 61, 45, 18, 2, and 0%, respectively. Late complications of YTx were related to the anatomic localization of the cyst, either presellar and retrosellar, e.g., a presellar (prechiasmatic/suprasellar) localization caused neuro-ophthalmological complications in 5.8% and internal carotid artery injury in 1.6%. The treatment of retrosellar (retrochiasmatic, suprasellar) tumors occasionally induced hypothalamic and/or pontomesencephalothalamic damage obviously by untoward radiation to the so-called perforating arteries. This occurred in 3.2% of these latter patients.


CONCLUSIONS
Despite sporadic complications, intracavitary YTx irradiation is a valuable treatment alternative for craniopharyngioma cysts, sometimes as part of a multimodality management in these tumors, especially in precarious surgical cases.
Julow
Jenö
J
Department of Neurosurgery, St. John's Hospital, Budapest, Hungary. h12494jul@ella.hu
Backlund
Erik-Olof
EO
Lányi
Ferenc
F
Hajda
Márta
M
Bálint
Katalin
K
Nyáry
István
I
Szeifert
György T
GT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003102:Colloids; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D003560:Cysts / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000008:administration & dosage*
D003102:Colloids; D015021:Yttrium Radioisotopes