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). Material and 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 followup 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 cm 3 (range 0.20-9.90) and post-FSRT 1.2 cm 3 (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.

Dosimetric and volumetric outcomes of combining cyst puncture through an Ommaya reservoir with index-optimized hypofractionated stereotactic radiotherapy in the treatment of craniopharyngioma

“…Except for Patient #2, all Dmax were lower for the reference plane in our dosimetry comparison. In contrast to the visual deterioration found to be associated with fractionated stereotactic radiosurgery in several studies [23][24][25][26], the visual impairment had improved after treatment for three of our six patients.…”

Cerebral infarction after fractionated stereotactic radiation therapy of benign anterior skull base tumors

“…Visual outcome and tumor control of a subgroup of anterior skull base meningiomas and pituitary adenomas from this cohort, treated in the years 1999–2009, have been described elsewhere [1] . Also, visual outcome, pituitary function and tumor control of all 15 of these craniopharyngioma patients 1999–2015 have been previously reported [9] .…”

Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review

“…Optic neuropathy was observed in 319 patients (prevalence = 2.0% [CI 95% = 0.028–0.034]). The diagnosis time of optic neuropathy was reported in 35 studies, with a mean of 36 months following irradiation (range, 3–108 months) [ 1 , 19 , 22 , 26 , 28 , 35 , 39 , 40 , 41 , 42 , 43 , 45 , 49 , 51 , 52 , 54 , 55 , 59 , 60 , 61 , 62 , 65 , 71 , 73 , 75 , 77 , 79 , 81 , 85 , 87 , 89 ]. Optic neuropathy prevalence was observed at prescribed doses of >50 Gy and <50 Gy at 4.5% and 1.7%, respectively.…”