Long-term outcomes of stereotactic intracavitary brachytherapy for cystic craniopharyngiomas

Abstract

Objective To assess the long-term outcomes of stereotactic intracystic brachytherapy for the treatment of cystic craniopharyngiomas. Methods A total of 141 consecutive patients with cystic craniopharyngioma treated by stereotactic intracystic phosphorus-32 at Department of Neurosurgery, Navy General Hospital of PLA from January 1996 to December 2015. There were 85 males and 56 females and the mean age was 40.1 years (range: 3-72 years). The calculated cumulative beta dose aimed at the inner surface of the cyst wall was 250 Gy. Results All patients were followed up for 1.0-19.5 years with an average of 9.7±4.5 years. The decreased visual acuity had improved in 68.6% (59/86) of the patients in long-term result. The total tumor response rate was 86.5% (122 cases) including the total response accounting for 44.0% (62 cases), partial response accounting for 36.2% (51 cases) and stable response accounting for 6.3% (9 cases). The rate of no response was 13.5% (19 cases). The recurrence rate was 17% (24 cases). The side effects that occurred during follow-up period included worsening of visual acuity in 13 (9.2%), the third nerve palsy in 2 (1.4%), internal carotid artery occlusion in 1(0.7%), new-onset sexual dysfunction in 5 (3.5%), diabetes insipidus in 7 (5.0%), obesity in 12 (8.5%) and cognitive dysfunction in 10 (7.1%) patients, respectively. The late complication rate was 35.5% (50/141). The mean survival after treatment was 120 months. The actuarial 5-, 10- and 15-yr survival rates were 97.9% (138 cases), 92.9% (131 cases) and 89.3% (126 cases), respectively. Conclusion Stereotactic intracavitary brachytherapy is a valuable treatment alternative for cystic craniopharyngioma, particularly for patients with high surgical risk and recurrent tumors. Key words: Cystic craniopharyngioma; Stereotactic radiosurgery; Phosphorus radioisotopes; Treatment outcome; Long-term