Long-term disease control and toxicity outcomes following surgery and intensity modulated radiation therapy (IMRT) in pediatric craniopharyngioma

• Published in: Radiotherapy and oncology 2015-02, Vol.114 (2), p.224-229
• Main Authors: Greenfield, Brad J, Okcu, Mehmet F, Baxter, Patricia A, Chintagumpala, Murali, Teh, Bin S, Dauser, Robert C, Su, Jack, Desai, Snehal S, Paulino, Arnold C
• Format: Article
• Language: English
• Subjects: Adolescent; Brain tumor; Child; Child, Preschool; Craniopharyngioma; Craniopharyngioma - radiotherapy; Craniopharyngioma - surgery; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Intensity modulated radiation therapy; Male; Pediatric tumor; Pituitary Neoplasms - radiotherapy; Pituitary Neoplasms - surgery; Radiation Injuries - diagnosis; Radiation Injuries - etiology; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2014.11.035

Abstract Purpose To report long-term progression-free survival (PFS) and late-toxicity outcomes in pediatric craniopharyngioma patients treated with IMRT. Patients and methods Twenty-four children were treated with IMRT to a median dose of 50.4 Gy (range, 49.8–54 Gy). The clinical target volume (CTV) was the gross tumor volume (GTV) with a 1 cm margin. The planning target volume (PTV) was the CTV with a 3–5 mm margin. Median follow-up was 107.3 months. Results The 5- and 10-year PFS rates were 65.8% and 60.7%. The 5- and 10-year cystic PFS rates were 70.2% and 65.2% while the 5- and 10-year solid PFS were the same at 90.7%. Endocrinopathy was seen in 42% at initial diagnosis and in 74% after surgical intervention, prior to IMRT. Hypothalamic dysfunction and visual deficits were associated with increasing PTV and number of surgical interventions. Conclusions IMRT is a viable treatment option for pediatric craniopharyngioma. Despite the use of IMRT, majority of the craniopharyngioma patients experienced long-term toxicity, many of which present prior to radiotherapy. Limitations of retrospective analyses on small patient cohort elicit the need for a prospective multi-institutional study to determine the absolute benefit of IMRT in pediatric craniopharyngioma.