Craniopharyngioma: The Controversy Regarding Radiotherapy

Abstract

In an attempt to derive a consensus for rational therapy of craniopharyngioma, pertinent recent literature has been reviewed. By seeking answers to specific questions, I have tried to remove personal bias from the conclusions. A consensus is suggested.

Radical Resections of Childhood Craniopharyngiomas

“…The only excep tion was the case with an inadvertently transplanted mass in the frontal pole. A similar case has been reported [22]. The length of follow-up in our series may be too short to evaluate late recurrences as craniopharyngiomas can re cur 20-30 years later [23][24][25].…”

“…After subtotal resection and RT. recurrence rates had been reported to be 26-30% [21,22], Hoff and Patterson [26] reported 63% recurrence rate in 10 years. Operative morbidity and mortality for recurrence, particularly after RT, arc signifi cantly worse [3.…”

“…5 had normal postoperative CT scans and 8 had either cal cium or some enhancing tissue on CT. Others reported varying recurrence rates from 23 to 50% [9, 10. 21], According to the literature review done by Amacher [22] 17 (18.5%) recurrences were documented after 92 total resections. However, zero recurrences in the primary sel lar and parasellar location following total resection which had been confirmed by surgery and postoperative imag ing studies was documented in our series.…”

“…Much literary attention has been given to the respon siveness of craniopharyngiomas to radiation [6], Accord ing to the Amacher's literature review [22], the recurrence rate was 74.8% after subtotal resection alone as opposed to 30.4% after a combination of subtotal resection and RT. More conservative methods were reported by Fischer et al [1].…”

Craniopharyngiomas. Historical aspects of their management

“…rence. 13 Yet opinion on the optimal management of these tumours remained divergent, with, for example, Mori et al in 1980 asserting that a craniopharyngioma "should be considered as malignant…therefore, no forceful attempt should be made to totally extirpate it and the operation should, as a rule, be palliative". 14 Endocrine and radiological support continued to improve, but there were inadequate data to favour any one of the various evolving surgical treatment options.…”