Radiosurgery for craniopharyngioma.
OBJECTIVE
To analyze the outcomes of gamma knife stereotactic radiosurgery (SRS) for residual or recurrent craniopharyngiomas and evaluate the factors that optimized the tumor control rates.


METHODS
A total of 46 patients with craniopharyngiomas underwent 51 SRS procedures at University of Pittsburgh between 1988 and 2007. The median tumor volume was 1.0 cm(3) (range, 0.07-8.0). The median prescription dose delivered to the tumor margin was 13.0 Gy (range, 9-20). The median maximal dose was 26.0 Gy (range, 20-50). The mean follow-up time was 62.2 months (range, 12-232).


RESULTS
The overall survival rate after SRS was 97.1% at 5 years. The 3- and 5-year progression-free survival rates (solid tumor control) were both 91.6%. The overall local control rate (for both solid tumor and cyst control) was 91%, 81%, and 68% at 1, 3, and 5 years, respectively. No patients with normal pituitary function developed hypopopituitarism after SRS. Two patients developed homonymous hemianopsia owing to tumor progression after SRS. Among the factors examined, complete radiosurgical coverage was a significant favorable prognostic factor.


CONCLUSIONS
SRS is a safe and effective minimally invasive option for the management of residual or recurrent craniopharyngiomas. Complete radiosurgical coverage of the tumor was associated with better tumor control.
Niranjan
Ajay
A
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. niranjana@upmc.edu
Kano
Hideyuki
H
Mathieu
David
D
Kondziolka
Douglas
D
Flickinger
John C
JC
Lunsford
L Dade
LD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D010911:Pituitary Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult