title: Long-term outcomes and complications in patients with craniopharyngioma: the British Columbia Cancer Agency experience.
abstract: OBJECTIVE
  We report long-term outcomes and complications of craniopharyngioma patients referred to our institution.
  
  
  METHODS
  Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy.
  
  
  RESULTS
  Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07).
  
  
  CONCLUSIONS
  We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: andrealo@gmail.com.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Lo
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: A Fuchsia
authors.initials: AF
authors.lastname: Howard
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Nichol
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Keerat
authors.initials: K
authors.lastname: Sidhu
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Farah
authors.initials: F
authors.lastname: Abdulsatar
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada.
authors.forename: Haroon
authors.initials: H
authors.lastname: Hasan
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada; Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Goddard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001761:Bleomycin / Q000627:therapeutic use; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001761:Bleomycin