Long-Term Outcome of Surgery and Radiation Treatment for Craniopharyngioma

Abstract

<h3>Purpose/Objective(s)</h3> Treatment of craniopharyngioma, a rare but benign neoplasm, typically entails gross total resection (GTR) or subtotal resection followed by adjuvant radiation (STR-RT). We analyzed progression free survival (PFS) in the adult population undergoing gross total resection versus subtotal resection followed by radiotherapy (RT). <h3>Materials/Methods</h3> A retrospective review was conducted on 67 consecutive patients who were treated for craniopharyngioma. All patients received surgical resection. Patients that had STR also received postoperative radiation treatment. A median dose of 54 Gy (50.4 – 54 Gy) was used with typical dose per fraction of 1.8 Gy five times per week. Three patients were excluded from analysis due to death shortly after surgery (n=1) and no adjuvant RT following STR (n=2) for a total of 64 patients. Regular follow up examinations included contrast MRI scans, physical exams, and clinical evaluation. <h3>Results</h3> Median age was 43 years (19 – 79 years). GTR was achieved in 35 patients and STR-RT in 30 patients. Median tumor size of GTR was 8.64 cm³ (range 1.8 – 40.1 cm³, mean 13.7 cm³) and 19.6 cm³ (range 2.5 – 116.3 cm³, mean 26.2 cm³) for STR-RT (p = 0.03). At a median follow up of 84 months (4 – 255 months) local control rate for all patients treated with GTR or STR-RT was 89.3% at 2 years, 80.1% at 5 years and 73.9% at 10 years. There was one death a week following initial surgery and 2 patients who had STR with no adjuvant RT both had local failure requiring additional intervention at 9 and 26 months. Of 35 patients that had GTR, local control was 91.4% at 2 years, 74.3% at 5 years, and 65.7% at 10 years. Of 12 patients with GTR requiring additional intervention with surgery, RT, or both 100% (n = 12) are stable at last follow up. For the 30 patients with STR-RT local control was 86.7% at 2 years, 86.7% at 5 years and 83.3% at 10 years. 5 patients that underwent STR and adjuvant RT required additional surgical intervention with 100% of patients (n = 5) stable at last follow up. The hazard ratio of STR and RT compared to GTR is 0.49 (CI 0.19 – 1.26), with no significant difference of progression free survival (p = 0.33). <h3>Conclusion</h3> Long term results for patients with craniopharyngioma that underwent subtotal resection followed by radiotherapy demonstrate equivalent local control as compared to gross total resection.