Stereotactic radiosurgery of residual or recurrent craniopharyngioma, after surgery, with or without radiation therapy

Abstract

Neuro-Oncology n J U LY 2 0 0 1 159 This study evaluated the role of stereotactic radiosurgery in the multimodality management of craniopharyngioma patients whose prior therapies failed. Ten consecutive patients (3 males and 7 females) had radiosurgery for craniopharyngioma during a 10-year interval. Their ages ranged from 9 to 64 years (median, 14.5 years). The median interval between diagnosis and radiosurgery was 46.5 months. In total, 12 stereotactic radiosurgical procedures were performed to control the solid component of the tumor (2 intrasellar and 10 suprasellar tumors). The median tumor volume was 1.35 cm 3 . One to 9 isocenters with different beam diameters were used; the median marginal dose was 16.4 Gy; and the dose to the optic apparatus was limited to less than 8 Gy. Clinical and imaging follow-up data were obtained at a median of 63 months (range, 13-150 months) from radiosurgery. Overall, 7 of 12 tumors became smaller or vanished within a median of 8.5 months. Prior visual defects objectively improved in 6 patients. One patient with prior visual defect deteriorated further and lost vision 9 months after radiosurgery. Multimodality therapy is often necessary for patients with refractory solid and cystic craniopharyngiomas. Stereotactic radiosurgery is a reasonable option in select patients with small recurrent or residual craniopharyngioma. Neuro-Oncology 3, 159-166, 2001 (Posted to Neuro-Oncology [serial online], Doc. 00-049, May 7, 2001

Comparison of Outcomes following Primary and Repeat Resection of Craniopharyngioma

“…17 Coupled with adjuvant radiation therapy, excellent disease control can be achieved following reoperation even in the absence of an aggressive GTR. 20,21 More recent reports have argued that endonasal resection can be implemented regardless of tumor size or location with superior safety profiles, and thus may be the preferred approach for initial craniopharyngioma resection. [22][23][24] How-ever, experience varies across institutions and taking a "one size fits all" approach may lead to suboptimal approaches for an individual tumor.…”

“…17 Coupled with adjuvant radiation therapy, excellent disease control can be achieved following reoperation even in the absence of an aggressive GTR. 20 21…”

Reirradiation for recurrent craniopharyngioma

“…Chiou et al evaluated the role of salvage stereotactic radiosurgery for treatment of craniopharyngioma in ten patients, one of whom had prior external beam RT. 20 Vision initially deteriorated 5 months post-stereotactic radiosurgery (SRS) but subsequently improved 10 months after SRS. In a separate study of 97 patients who underwent conformal radiation therapy for craniopharyngioma, 2 patients were subsequently treated with Gamma Knife surgery for recurrent disease: at last follow-up, one patient had progressive disease, and the other had stable disease.…”

“…However, in this study formal neuropsychological testing was not performed. 20 Systematic, serial neuropsychological assessments that include measures of memory and executive functions, acquired before and several years after reirradiation are warranted to understand potential detrimental effects of this treatment on cognitive functioning in craniopharyngioma.…”