title: Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort.
abstract: BACKGROUND
  The purpose of this study was to examine visual outcome, endocrine function and tumor control in a prospective cohort of craniopharyngioma patients, treated with fractionated stereotactic radiation therapy (FSRT).
  
  
  METHODS
  Sixteen adult patients with craniopharyngiomas were eligible for analysis. They were treated with linear accelerator-based FSRT during 1999-2015. In all cases, diagnosis was confirmed by histological analysis. The prescription dose to the tumor was 54 Gy (median, range 48-54) in 1.8 or 2.0 Gy per fraction, and the maximum radiation dose to the optic nerves and chiasm was 54.2 Gy (median, range 48.6-60.0) for the cohort. Serial ophthalmological and endocrine evaluations and magnetic resonance imaging (MRI) scans were performed at regular intervals. Median follow-up was 3.3 years (range 1.1-14.1), 3.7 years (range 0.8-15.2), and 3.6 years (range 0.7-13.1) for visual outcome, endocrine function, and tumor control, respectively.
  
  
  RESULTS
  Visual acuity impairment was present in 10 patients (62.5%) and visual field defects were present in 12 patients (75%) before FSRT. One patient developed radiation-induced optic neuropathy at seven years after FSRT. Thirteen of 16 patients (81.3%) had pituitary deficiency before FSRT, and did not develop further pituitary deficiency after FSRT. Mean tumor volume pre-FSRT was 2.72 cm3(range 0.20-9.90) and post-FSRT 1.2 cm3(range 0.00-13.10). Tumor control rate was 81.3% at two, five, and 10 years after FSRT.
  
  
  CONCLUSIONS
  FSRT was relatively safe in this prospective cohort of craniopharyngiomas, with only one case of radiation-induced optic neuropathy and no case of new endocrinopathy. Tumor control rate was acceptable.
authors.affiliation: a Department of Neurorehabilitation, Traumatic Brain Injury Unit , Rigshospitalet , Hvidovre , Denmark.|b Department of Neurosurgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Arnar
authors.initials: A
authors.lastname: Astradsson
authors.affiliation: c Department of Radiation Oncology , Finsen Center, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Munck Af Rosenschöld
authors.affiliation: d Department of Medical Endocrinology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.affiliation: b Department of Neurosurgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Poulsgaard
authors.affiliation: e Department of Ophthalmology , Rigshospitalet , Glostrup , Denmark.
authors.forename: Anne Katrine
authors.initials: AK
authors.lastname: Wiencke
authors.affiliation: c Department of Radiation Oncology , Finsen Center, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Ohlhues
authors.affiliation: c Department of Radiation Oncology , Finsen Center, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Svend Aage
authors.initials: SA
authors.lastname: Engelholm
authors.affiliation: f Department of Neuropathology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Broholm
authors.affiliation: b Department of Neurosurgery , Rigshospitalet , Copenhagen , Denmark.|d Department of Medical Endocrinology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Emil
authors.initials: E
authors.lastname: Hansen Møller
authors.affiliation: d Department of Medical Endocrinology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Klose
authors.affiliation: c Department of Radiation Oncology , Finsen Center, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Roed
authors.affiliation: b Department of Neurosurgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Juhler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000378:metabolism / Q000502:physiology / Q000528:radiation effects*; D010907:Pituitary Hormones / Q000378:metabolism*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D014785:Vision, Ocular / Q000502:physiology / Q000528:radiation effects*; D055815:Young Adult
chemical_list: D010907:Pituitary Hormones