title: Long-term clinical outcomes following treatment of childhood craniopharyngioma.
abstract: OBJECTIVE
  To review our institution's experience with treatment of craniopharyngioma in children, and to report long-term treatment outcomes stratified by treatment era to assess whether modern treatment techniques result in improvements in local control and survival.
  
  
  METHODS
  We retrospectively reviewed the records of 100 children who underwent surgery for craniopharygioma at Children's Hospital Boston (CHB) from August 1976 to March 2003. Of these, 79 children (median age 8.5 years) had initial treatment at CHB and sufficient follow-up data to be included in this analysis. We report their treatment course, recurrence rates, and treatment-related morbidity. We compared the results in two different treatment eras based on changes in surgical approach at CHB.
  
  
  RESULTS
  Thirty-six patients underwent initial treatment with surgery alone; 63% treated prior to 1988 recurred and 36% treated after 1988 recurred. Recurrence rates following combined modality therapy (CMT) with limited surgery followed by radiation were 21 and 5% in the pre- and post-1988 eras, respectively. Accounting for treatment era, patients treated with surgery alone were 7.7 times as likely to recur as those treated with CMT (95%CI: 2.0, 28.7). In the Cox regression model, there was no significant difference in local control or overall survival based on treatment era; initial treatment remained the only statistically significant variable (P = 0.02).
  
  
  CONCLUSIONS
  Advancements in treatment techniques have improved local control in children diagnosed with craniopharyngioma. The excellent survival rates necessitate long-term patient follow-up to identify and manage any treatment-related effects, including second tumors, vascular abnormalities, and endocrinopathies.
authors.affiliation: Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA. kwinkfield@partners.org
authors.forename: Karen M
authors.initials: KM
authors.lastname: Winkfield
authors.forename: Henry K
authors.initials: HK
authors.lastname: Tsai
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.forename: Elysia
authors.initials: E
authors.lastname: Larson
authors.forename: Donna
authors.initials: D
authors.lastname: Neuberg
authors.forename: Scott L
authors.initials: SL
authors.lastname: Pomeroy
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Ullrich
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Cohen
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kieran
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.forename: Liliana C
authors.initials: LC
authors.lastname: Goumnerova
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult