title: Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children.
abstract: OBJECTIVE
  Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP.
  
  
  METHODS
  Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months).
  
  
  RESULTS
  Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively.
  
  
  CONCLUSIONS
  Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations.
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. mauritius.hoevels@uk-koeln.de.|Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany. mauritius.hoevels@uk-koeln.de.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. maaroufm@kliniken-koeln.de.|Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany. maaroufm@kliniken-koeln.de.
authors.forename: Faycal
authors.initials: F
authors.lastname: El Majdoub
authors.affiliation: Department of Neurosurgery, University Hospital of Munich, Marchioninistrasse 15, 81377, Munich, Germany. manuel.fuetsch@med.uni-muenchen.de.
authors.forename: Manuel
authors.initials: M
authors.lastname: Fuetsch
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany.
authors.forename: Mauritius
authors.initials: M
authors.lastname: Hoevels
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Germany. stereotaxie@barbaraklinik.de.
authors.forename: Ralph
authors.initials: R
authors.lastname: Lehrke
authors.affiliation: Department Pediatric Oncology, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. frank.berthold@uk-koeln.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. jacqueline.lemme@med.ovgu.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Voges
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany. volkersturm@online.de.|Department of Neurosurgery, University Hospital of Wurzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany. volkersturm@online.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
mesh_terms: D000293:Adolescent; D001918:Brachytherapy / Q000379:methods*; D020863:Central Nervous System Cysts / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D003397:Craniopharyngioma / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010761:Phosphorus Radioisotopes; D019275:Radiopharmaceuticals
keywords: Intracavitary brachytherapy; Pediatrics; Phosphorus-32; Survival; Treatment outcome