Role of radiosurgery in craniopharyngiomas: a preliminary report.
Amendola BE, Wolf A, Coy SR, Amendola MA.
Miami Neuroscience Center, Coral Gables, Florida 33143, USA.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
PURPOSE: The purpose of this retrospective review is to evaluate our experience using radiosurgery in the management of craniopharyngiomas. MATERIALS AND METHODS: Fourteen patients, 6 males and 8 females, ages ranging from 3 to 44 years of age, were treated with radiosurgery from February 1994 through December 2000 for primary or recurrent craniopharyngioma. There were two adults and 12 children. All patients were treated with the Leksell Gamma units Model U or C. The mean minimum dose was 14 Gy ranging from 11 to 20 Gy and the mean maximum dose was 29 Gy ranging from 24 to 40 Gy. Volume of treatment ranged from 0.1 to 26.5 cm(3). The dose to critical structures was below 8 Gy to the optic chiasm and below 14 Gy to the brain stem. One of the 14 patients had previous conventional radiation therapy. RESULTS: All patients are alive and with out evidence of recurrent disease 6-86 months after treatment. Only two patients required retreatment. CONCLUSIONS: Although craniopharyngioma is a benign tumor, its location makes even advanced microsurgical techniques difficult to perform. Radiosurgery obviates the shortcomings of surgical resection near the hypothalamic-pituitary axis without the morbidity of open surgery. Copyright 2003 Wiley-Liss, Inc.
-
-
Stereotactic radiosurgery. XVII: Recurrent intrasellar craniopharyngioma.
Jackson AS, St George EJ, Hayward RJ, Plowman PN.
Department of Radiotherapy, St Bartholomew's Hospital, London Radiosurgical Centre, London, UK.
Stereotactic radiosurgery for craniopharyngioma is usually a high risk procedure due to the intimate relationship of the tumour to the optic chiasm and conservative dosing has been advocated to reduce complication rates. In 2002, in a publication from Karolinska Hospital, Sweden, 13 out of 21 patients received only a marginal dose of 6 Gy (not considered a radical dose) and 11 out of 13 tumours progressed. This recent report must argue against single dose stereotactic radiosurgery as the primary radiation therapy modality in most cases. However, where the disease is 'away' from the optic apparatus, such constraints do not apply. We here report the successful treatment of three consecutive patients whose craniopharyngioma was confined to the pituitary fossa, and a finite distance from the optic pathways and in whom optimal dosing was employed.
-
-
A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery.
Stafford SL, Pollock BE, Leavitt JA, Foote RL, Brown PD, Link MJ, Gorman DA, Schomberg PJ.
Division of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
PURPOSE: To evaluate the risk of clinically significant radiation optic neuropathy (RON) for patients having stereotactic radiosurgery of benign tumors adjacent to the optic apparatus. METHODS AND MATERIALS: We reviewed the dose plans and clinical outcomes of 218 gamma knife procedures (215 patients) for tumors of the sellar and parasellar region (meningiomas, n = 122; pituitary adenomas, n = 89; craniopharyngiomas, n = 7 patients). Previous surgery or radiation therapy was performed in 156 (66%) and 24 (11%) patients, respectively. Median follow-up was 40 months (range 4-115). RESULTS: The median maximum radiation dose to the optic nerve was 10 Gy (range 0.4-16.0). Four patients (1.9%) developed RON at a median of 48 months after radiosurgery. All had prior surgery, and 3 of 4 had external beam radiotherapy (EBRT) in their management either before (n = 2) or adjuvantly (n = 1). The risk of developing a clinically significant RON was 1.1% for patients receiving 12 Gy or less. Patients receiving prior or concurrent EBRT had a greater risk of developing RON after radiosurgery (p = 0.004). CONCLUSION: RON occurred in less than 2% of our patients, despite the majority (73%) receiving more than 8 Gy to a short segment of the optic apparatus. Knowledge of the dose tolerance of these structures permits physicians to be more aggressive in treating patients with sellar or parasellar tumors, especially those with hormone-producing pituitary adenomas that appear to require higher doses to achieve biochemical remission.
-
-
Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery.
Barajas MA, Ramirez-Guzman G, Rodriguez-Vazquez C, Toledo-Buenrostro V, Velasquez-Santana H, del Robles RV, Cuevas-Solorzano A, Rodriguez-Hernandez G.
Neurosciences Division, Gamma Knife Unit, Department of Neuroradiology, Hospital San Javier, Guadalajara, Jalisco, Mexico.
OBJECT: The goal of this study was to examine the role of gamma knife radiosurgery (GKS) and adjuvant neuroendoscopic procedures by assessing the outcome in 10 patients with craniopharyngiomas who were treated between 1998 and 2001. METHODS: In 10 consecutive patients (six males and four females, mean age 12 years [range 7-32 years]), there were nine mixed and one solid craniopharyngioma. In the last three cases, neuroendoscopic procedures were conducted. Two cases required insertion of an Ommaya reservoir. In another case partial removal of the cyst wall was performed using an endoscope to create a communication with the cerebrospinal pathways and thereby preclude the need for shunt insertion. CONCLUSIONS: Multimodal management of craniopharyngiomas seems to provide a better rate of survival and greater long-term disease control. It is suggested that GKS combined with adjuvant neuroendoscopy should be used as an alternative in treating recurrent or residual craniopharyngiomas if additional microsurgical removal cannot guarantee a cure.
-
-
Gamma knife radiosurgery for craniopharyngiomas: long-term results in the first Swedish patients.
Ulfarsson E, Lindquist C, Roberts M, Rahn T, Lindquist M, Thoren M, Lippitz B.
Department of Neurosurgery, Neuroradiology and Endocrinology, Karolinska Hospital, Stockholm, Sweden.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
OBJECT: The purpose of this study was to assess the long-term treatment efficacy and morbidity of patients who undergo gamma knife radiosurgery (GKS) for craniopharyngioma. METHODS: Twenty-one consecutive Swedish patients were evaluated retrospectively: 11 children (< or = 15 years) and 10 adults. The time from diagnosis to the most recent follow-up imaging study was 6.3 to 34.3 years (mean 18.2 years, median 16.8 years). Tumor volumes and morbidity from GKS or other treatments were assessed at the time of the most recent imaging study or at the time of a subsequent new treatment. The observation period ranged from 0.5 to 29 years (mean 7.5 years, median 3.5 years). The prescription dose ranged from less than 3 Gy to 25 Gy. The mean tumor volume was 7.8 cm3 (range 0.4-33 cm3). There were 22 tumors in 21 patients treated with GKS. Five of these tumors were reduced in size, three were unchanged, and 14 increased. Tumor progression correlated with a low dose to the tumor margin. Eleven (85%) of 13 tumors that received a dose of less than 6 Gy to the margin increased in size, whereas only three (33%) of nine tumors that received 6 Gy increased. This difference was statistically significant (p = 0.01). In five of six patients tumors that became smaller after GKS there were no recurrences within a mean follow-up period of 12 years. Nine (82%) of 11 tumors in children ultimately increased after GKS, compared with five (50%) of 10 in adults. In eight patients there was a deterioration of visual function. In all except one this could be related to a volume increase but radiation-induced damage could not be excluded as a factor in any of them. Four patients developed pituitary deficiencies. CONCLUSIONS: Gamma knife radiosurgery is effective in controlling growth of craniopharyngiomas with a minimum dose of 6 Gy. The findings also suggest that other stereotactic techniques, such as cyst aspiration and intracystic treatment, are only of value in reducing tumor volume in preparation for safe GKS.
-
-
Fractionated stereotactic radiotherapy for craniopharyngiomas.
Schulz-Ertner D, Frank C, Herfarth KK, Rhein B, Wannenmacher M, Debus J.
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
PURPOSE: To investigate outcome and toxicity after fractionated stereotactic radiation therapy (FSRT) in patients with craniopharyngiomas. METHODS AND MATERIALS: Twenty-six patients with craniopharyngiomas were treated with FSRT between May 1989 and February 2001. Median age was 33.5 years (range: 5-57 years). Nine patients received FSRT after surgery as primary treatment, and 17 patients were irradiated for recurrent tumor or progressive growth after initial surgery. Median target dose was 52.2 Gy (range: 50.0-57.6 Gy) with conventional fractionation. Follow-up included MRI and neurologic, ophthalmologic, and endocrinologic examinations. RESULTS: The median follow-up was 43 months (range: 7-143 months). The actuarial local control rate and actuarial overall survival rates were 100% and 100%, respectively, at 5 years and 100% and 83%, respectively, at 10 years. Four patients showed complete response, 14 patients showed partial response, and 8 patients remained stable. In 5 patients, vision improved after radiation therapy. Acute toxicity was mild. One patient required cyst drainage 3 months after radiotherapy. Late toxicity after radiotherapy included impairment of hormone function in 3 out of 18 patients at risk. We did not observe any vision impairment, radionecrosis, or secondary malignancies. CONCLUSIONS: FSRT is effective and safe in the treatment of cystic craniopharyngiomas. Toxicity is extremely low using this conformal technique.
-
-
Craniopharyngioma: the St. Jude Children's Research Hospital experience 1984-2001.
Merchant TE, Kiehna EN, Sanford RA, Mulhern RK, Thompson SJ, Wilson MW, Lustig RH, Kun LE.
Department of Radiation Oncology, St. Jude Children's Research Hospital, 332 N Lauderdale Street, Memphis, TN 38105-2794, USA.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
PURPOSE: To review our institution's experience in the treatment of craniopharyngioma and assess the merits of initial therapy with limited surgery and irradiation. METHODS AND MATERIALS: The data of 30 patients (median age 8.6 years) with a diagnosis of craniopharyngioma between April 1984 and September 1997 were reviewed. Their course of treatment, neurologic, endocrine, and cognitive function, and quality of life at last follow-up were compared. RESULTS: Fifteen patients were initially treated with surgery (8 required irradiation after relapse) and 15 with limited surgery and irradiation (2 required additional treatment for tumor progression). Only 1 patient died of tumor progression. The surgery group lost a mean of 9.8 points in full-scale IQ, and the combined-modality group lost only 1.25 points (p <0.063). Patients in the surgery group who had relapses (n = 9) lost a mean of 13.1 points (p <0.067). A loss of 10 points was considered clinically significant. The surgery group also had more frequent neurologic, ophthalmic, and endocrine complications. The mean Health Utility Index (a functional quality-of-life index) was higher for the combined-modality group (0.85) than for the surgery group (0.71; p <0.063, one-sided t test). CONCLUSIONS: The acute neurologic, cognitive, and endocrine effects of surgery often affect long-term function and quality of life. Our experience suggests that limited surgery and radiotherapy cause lesser or comparable sequelae. Diabetes insipidus was the only endocrine deficiency that differed substantially in frequency between the two groups. Newer radiation planning and delivery techniques may make a combined-modality approach a good initial option for most patients.
-
-
Initial clinical results of stereotactic radiotherapy for the treatment of craniopharyngiomas.
Selch MT, DeSalles AA, Wade M, Lee SP, Solberg TD, Wallace RE, Ford JM, Rubino G, Cabatan-Awang C, Withers HR.
Department of Radiation Oncology, School of Medicine, University of California, Los Angeles CA 90095, USA.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
The efficacy and toxicity of stereotactic radiotherapy (SRT) for the treatment of craniopharyngioma has been retrospectively evaluated in 16 patients. The median tumor diameter was 2.8 cm (range 1.5-6.1) and the median tumor volume was 7.7 cc (range 0.7-62.8). SRT was delivered to a single isocenter using a dedicated 6 MV linear accelerator to patients immobilized with a relocatable stereotactic head frame. The three-year actuarial overall survival was 93% and the rate of survival free of any imaging evidence of progressive disease was 75%. The three-year actuarial survival rates free of solid tumor growth or cyst enlargement were 94% and 81% respectively. Our results suggest that SRT is a safe and effective treatment approach for patients with craniopharyngioma. Long-term follow-up is required to determine whether the normal tissue-sparing inherent with SRT results in reduction of the neurocognitive effects of conventional radiotherapy for craniopharyngioma. SRT can be delivered to craniopharyngioma that may be difficult to treat with stereotactic radiosurgery due to proximity of the optic chiasm. Further clinical experience is necessary to determine the clinical utility of beam shaping in the setting of SRT.
-
-
Regression of a large solid papillary craniopharyngioma following fractionated external radiotherapy.
Honegger J, Grabenbauer GG, Paulus W, Fahlbusch R.
Department of Neurosurgery, University of Erlangen-Nurnberg, Erlangen, Germany.
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
We present a patient harboring a large squamous papillary craniopharyngioma. The diagnosis was confirmed by a stereotactic biopsy. Because of vegetative symptoms indicating hypothalamic derangement, we were reluctant to perform surgical resection. Following fractionated megavoltage radiotherapy, MR imaging and CT demonstrated complete regression of the craniopharyngioma and the patient recovered from endocrine deficiency, chiasmal syndrome and vegetative hypothalamic symptoms.
-
-
Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results.
Pollock BE, Lunsford LD, Kondziolka D, Levine G, Flickinger JC.
Department of Neurological Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
PURPOSE: The management of patients with craniopharyngiomas is often multifaceted and multidisciplinary. The purpose of this study was to examine the results of phosphorus-32 intracavitary irradiation in the treatment of patients with predominately cystic craniopharyngiomas. METHODS AND MATERIALS: Thirty patients with cystic craniopharyngiomas underwent phosphorus-32 intracavitary irradiation at our center between 1981 and 1993. The median patient age was 26 years (range, 3-70 years). Thirteen patients had intracavitary irradiation as the primary surgery for their cystic tumors, whereas 17 patients had adjuvant intracavitary irradiation after microsurgical resection, fractionated radiotherapy, or both. Patients in the adjuvant treatment group were more likely to have preoperative anterior pituitary insufficiency (p = 0.008 Fischer exact test) and diabetes insipidus (p = 0.003 Fischer exact test). The median follow-up was 37 months (mean, 46 months, range, 7-116 months). RESULTS: Phosphorus-32 intracavitary irradiation resulted in cyst regression in 28 of 32 treated cysts (88%). Ten patients (33%) have had tumor progression requiring further surgical intervention. Three patients (10%) died: two of tumor progression, and one of unrelated causes. Visual acuity and fields improved or remained stable in 63% of the patients. Fifteen patients had residual anterior pituitary function before intracavitary irradiation and 10 (67%) retained their preoperative endocrine status. New-onset diabetes insipidus occurred in 3 of 17 patients (18%) who had normal posterior pituitary function preoperatively. Fourteen of 20 adult patients (70%) continued to perform at their preoperative functional level; 3 of 5 pediatric patients who were age appropriate at the time of treatment continued to develop normally. No difference was noted between primary and adjuvant treatment patients with respect to cyst control, visual deterioration, or endocrine preservation after phosphorus-32 intracavitary irradiation. CONCLUSION: The goals of craniopharyngioma management should be tumor control with preservation of visual, endocrine, and cognitive function. Phosphorus-32 intracavitary irradiation is an important option that enhances the likelihood of achieving these goals in patients with primarily cystic craniopharyngiomas.
|
