title: Long-term disease control and toxicity outcomes following surgery and intensity modulated radiation therapy (IMRT) in pediatric craniopharyngioma.
abstract: OBJECTIVE
  To report long-term progression-free survival (PFS) and late-toxicity outcomes in pediatric craniopharyngioma patients treated with IMRT.
  
  
  METHODS
  Twenty-four children were treated with IMRT to a median dose of 50.4Gy (range, 49.8-54Gy). The clinical target volume (CTV) was the gross tumor volume (GTV) with a 1cm margin. The planning target volume (PTV) was the CTV with a 3-5mm margin. Median follow-up was 107.3months.
  
  
  RESULTS
  The 5- and 10-year PFS rates were 65.8% and 60.7%. The 5- and 10-year cystic PFS rates were 70.2% and 65.2% while the 5- and 10-year solid PFS were the same at 90.7%. Endocrinopathy was seen in 42% at initial diagnosis and in 74% after surgical intervention, prior to IMRT. Hypothalamic dysfunction and visual deficits were associated with increasing PTV and number of surgical interventions.
  
  
  CONCLUSIONS
  IMRT is a viable treatment option for pediatric craniopharyngioma. Despite the use of IMRT, majority of the craniopharyngioma patients experienced long-term toxicity, many of which present prior to radiotherapy. Limitations of retrospective analyses on small patient cohort elicit the need for a prospective multi-institutional study to determine the absolute benefit of IMRT in pediatric craniopharyngioma.
authors.affiliation: Baylor College of Medicine, United States.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Greenfield
authors.affiliation: Baylor College of Medicine, United States; Texas Children's Cancer and Hematology Center, United States.
authors.forename: Mehmet F
authors.initials: MF
authors.lastname: Okcu
authors.affiliation: Baylor College of Medicine, United States; Texas Children's Cancer and Hematology Center, United States.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Baxter
authors.affiliation: Baylor College of Medicine, United States; Texas Children's Cancer and Hematology Center, United States.
authors.forename: Murali
authors.initials: M
authors.lastname: Chintagumpala
authors.affiliation: Houston Methodist Hospital, United States.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.affiliation: Baylor College of Medicine, United States; Texas Children's Cancer and Hematology Center, United States.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Dauser
authors.affiliation: Baylor College of Medicine, United States; Texas Children's Cancer and Hematology Center, United States.
authors.forename: Jack
authors.initials: J
authors.lastname: Su
authors.affiliation: Houston Methodist Hospital, United States.
authors.forename: Snehal S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Baylor College of Medicine, United States; The University of Texas MD Anderson Cancer Center, United States; Texas Children's Cancer and Hematology Center, United States. Electronic address: apaulino@mdanderson.org.
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Brain tumor; Craniopharyngioma; Intensity modulated radiation therapy; Pediatric tumor