Radiosurgery Research Articles

Patient With Post-operative Recurrent Pancreatic Cancer Treated With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy: A Case Report

Patient With Post-operative Recurrent Pancreatic Cancer Treated With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy: A Case Report

Lesion filling index predicts brain arteriovenous malformation obliteration after Gamma knife radiosurgery: a hemodynamic analysis.

Hemodynamics significantly influences the clinical outcomes of brain arteriovenous malformations (AVM). This study aimed to determine if the lesion filling index (LFI), obtained via quantitative digital subtraction angiography (QDSA), can predict complete complete obliteration after Gamma knife radiosurgery (GKRS).We retrospectively reviewed AVM patients who underwent GKRS and DSA exams from 2011 to 2021. Clinical, angioarchitectural, and QDSA hemodynamic features were analyzed. The LFI, derived from QDSA, was evaluated as a predictor of complete complete obliteration post-SRS using Cox proportional hazards and Kaplan-Meier analyses.Among 118 AVMs with a mean follow-up of 5.76 ± 2.76 years, post-SRS complete obliteration was linked to reduced nidus volume (7.27 ± 12.3 vs. 19.2 ± 35.7 mm³, p = 0.049), smaller nidus diameter (26.0 ± 14.9 vs. 34.1 ± 19.8 mm, p = 0.015), and absence of feeding artery dilation (21.1% vs. 46.3%, p = 0.008). Higher Arterial Diagnostic Window (ADW) (972.27 ± 1615.53 vs. 515.29 ± 730.26, p = 0.036), higher LFI (905.31 ± 2288.37 vs. 249.65 ± 1092.46, p = 0.037), and lower Transnidal Relative Velocity (TRV), a parameter defined as the maximum diameter of AVM divided by the full width at half maximum (74.31 ± 95.67 vs. 137.80 ± 152.01, p = 0.021), were also associated with complete obliteration. After adjusting for confounders, only two variables-absence of feeding artery dilation (HR 0.35, 95%CI 0.16-0.78, p = 0.010) and higher LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006) remained significant predictors. The ROC curve identified 188.4 as the LFI cutoff, and Kaplan-Meier analysis confirmed LFI's predictive value (log-rank test, χ² = 12.776, p < 0.001).Elevated LFI and absence of feeding artery dilation predict AVM complete obliteration after GKRS, indicating that overfilling and low blood flow in the nidus may promote complete obliteration.

Long-term tumor control following repeat gamma-knife radiosurgery of growing pituitary adenomas: a population-based cohort study

BackgroundGamma Knife radiosurgery (GKRS) is a well-established treatment for residual or growing pituitary adenomas (PAs) post-partial resection. However, some PAs grow even after initial GKRS, for which the efficacy of repeat GKRS is unclear. The primary objective of this study was to determine long-term progression-free survival (PFS) following repeated GKRS in patients with PA. The secondary objective was to determine predictors of tumor progression in these patients.MethodsSingle-center, population-based consecutive cohort study of patients with recurrent PAs treated with repeated GKRS due to tumor progression between 1999 and 2022 at the Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. PFS and predictors of tumor growth were assessed.Results23 patients were included, with a median follow-up time of 6.3 years. The 5-year PFS rate was 57%, and the median duration from repeat GKRS to tumor progression was 2.6 years. Tumor growth after repeat GKRS occurred exclusively within the first three years post-treatment. Older age at the time of repeat GKRS was a significant predictor of continued tumor growth (OR 1.09, p = 0.036).ConclusionRepeat GKRS is a feasible treatment alternative for PAs that exhibit growth following initial GKRS.

Feasibility study of modularized pin ridge filter implementation in proton FLASH planning for liver stereotactic ablative body radiotherapy

Objective.We previously developed a FLASH planning framework for streamlined pin-ridge-filter (pin-RF) design, demonstrating its feasibility for single-energy proton FLASH planning. In this study, we refined the pin-RF design for easy assembly using reusable modules, focusing on its application in liver stereotactic ablative body radiotherapy (SABR).Approach.This framework generates an intermediate intensity-modulated proton therapy (IMPT) plan and translates it into step widths and thicknesses of pin-RFs for a single-energy FLASH plan. Parameters like energy spacing, monitor unit limit, and spot quantity were adjusted during IMPT planning, resulting in pin-RFs assembled using predefined modules with widths from 1 to 6 mm, each with a water-equivalent-thickness of 5 mm. This approach was validated on three liver SABR cases. FLASH doses, quantified using the FLASH effectiveness model at 1-5 Gy thresholds, were compared to conventional IMPT (IMPT-CONV) doses to assess clinical benefits.Main results.The highest demand for 6 mm width modules, moderate for 2-4 mm, and minimal for 1- and 5-mm modules were shown across all cases. At lower dose thresholds, the two-beam case reduced indicators including liverV21Gyand skinDmaxby >19.4%, while the three-beam cases showed reductions⩽11.4%, indicating the need for higher fractional beam doses for an enhanced FLASH effect. Positive clinical benefits were seen only in the two-beam case at the 5 Gy threshold. At the 1 Gy threshold, the two-beam FLASH plan outperformed the IMPT-CONV plan, reducing dose indicators for all relevant normal tissues by up to 31.2%. In contrast, the three-beam cases showed negative clinical benefits, with skinDmaxand liverV21Gyincreasing by up to 17.4% due to lower fractional beam doses and closer beam arrangements.Significance.This study evaluated the feasibility of modularizing streamlined pin-RFs in single-energy proton FLASH planning for liver SABR, offering guidance on optimal module composition and strategies to enhance FLASH planning.

Understanding the PULSAR effect in combined radiotherapy and immunotherapy using transformer-based attention mechanisms

PULSAR (personalized, ultra-fractionated stereotactic adaptive radiotherapy) is the adaptation of stereotactic ablative radiotherapy towards personalized cancer management. It has potential to harness the synergy between radiation therapy and immunotherapy, such as immune checkpoint inhibitors to amplify the anti-tumor immune response. For the first time, we applied a transformer-based attention mechanism to investigate the underlying interactions between combined PULSAR and PD-L1 blockade immunotherapy, based on the preliminary experimental results of a murine cancer model (Lewis Lung Carcinoma, LLC). The radiation and administration of α-PD-L1 were viewed as two external stimulation signals occurring in a temporal sequence. Our study demonstrates the utility of a transformer model in 1) predicting tumor changes in response to specific treatment schemes, and 2) generating self-attention and cross-attention maps. The cross-attention maps serve as a biological representation of the semantic similarity between source and target sentences in neural translation, offering insights into the causal relationships of the PULSAR effect. Our model offers a unique perspective with the potential to enhance the understanding of the temporal dependencies of the PULSAR effect on time, dose, and T cell dynamics. In a broader context, our proposed framework offers the potential to explore varying intervals and doses for subsequent treatments while monitoring the biological parameters impacted by these perturbations. This approach can lead to more personalized and rational radiation or drug interactions.

Efficacy of a thermoplastic mask and pneumatic abdominal compression device for immobilization in stereotactic ablative radiotherapy of spine metastases.

Stereotactic ablative radiotherapy (SABR) has become a key technique in management of spine metastases. With improved control over treatment plan dosimetry, there is a greater need for accurate patient positioning to guarantee agreement between the treatment plan and delivered dose. With serious potential complications such as fracture and myelopathy, the margins of error in SABR of the spine are minimal. In this study, we assessed the performance of two patient immobilization setups in SABR for spinal metastases. First, a Type-S head and shoulders mask (CQ Medical, Avondale, PA), and second, the BPL1 setup, which includes a wing board, vacuum bag, and the Respiratory Belt for the Body Pro-Lok ONE (CQ Medical, Avondale, PA). Immobilization was assessed using image-guided intrafraction repositioning shifts. Required planning target volume (PTV) margins were calculated based on repositioning data for 172 treated fractions using 2 standard deviation (2SD) and analytic approaches. Overall, 91.7% and 74.1% of fractions treated had total 3D repositioning shifts ≤3.0mm using the Type-S and BPL1 setups, respectively. In the thoracic spine, 43.2% and 46.5% of fractions had shifts ≤1.5mm for the respective setups. Suggested margins were under 3.5mm in all directions and use cases. In the posterior-anterior direction, the BPL1 setup had a 0.6mm smaller suggested margin for the thoracic spine compared to the Type-S setup, at 1.4mm, calculated using the analytic approach. Both the Type-S and BPL1 setups are effective for immobilization in spine SABR. The Type-S demonstrated superior immobilization in the upper spine and remains the clinical standard for cervical and upper thoracic spine positioning. The BPL1 setup showed effective immobilization in use cases treating the mid-to lower thoracic spine and lumbar spine and remains our clinical standard for those use cases. Results additionally demonstrate feasibility of potential PTV margin reduction.

Stereotactic ablative radiotherapy (SABR) for patients with lung tumor and severe pulmonary function impairment.

To evaluate clinical outcomes after SABR in a cohort of early-stage non-small cell lung cancer (NSCLC) or pulmonary metastases in chronic obstructive pulmonary disease (COPD) patients with forced expiratory volume in the first second predicted (FEV1) ≤ 50%. Retrospective single-center study was performed to analyze clinical outcomes and toxicities in COPD patients with severe lung dysfunction treated with SABR from 1st June 2015 to 31st October 2022. Thirty four patients (forty locations) were enrolled for analysis. Median follow-up was 2.9years. Median age was 73.5years (range, 65.6-80.1). FEV1 was 38% (range, 28.2-50.0) prior to radiotherapy. Median overall survival (OS) was 41.1months (95% CI 38.9-not reached). OS rates at 2-, 3-, and 5- years were 79%, 71%, and 36%, respectively. Cancer-specific survival rates at 2-, 3-, and 5- years were 96%, 96%, and 68%, respectively. Local control rates at 2-, 3-, and 5- years were 88%, 83%, and 83%, respectively. No grade 4 or 5 toxicity was observed. The most common acute toxicity was pneumonitis (38.2%), of which only 1 patient (2.9%) reported grade 3 acute toxicity. Lung SABR in patients with poor pulmonary function may be effective with acceptable toxicity.

Treatment Selection for the High-risk Patient with Stage I Non-Small Cell Lung Cancer: Sublobar Resection, Stereotactic Ablative Radiotherapy or Image-guided Thermal Ablation?,

Treatment Selection for the High-risk Patient with Stage I Non-Small Cell Lung Cancer: Sublobar Resection, Stereotactic Ablative Radiotherapy or Image-guided Thermal Ablation?,

The influence of cardiac substructure dose on survival in a large lung cancer stereotactic radiotherapy cohort using a robust personalized contour analysis

Background/Purpose: Radiation-induced cardiac toxicity in lung cancer patients has received increased attention since RTOG 0617. However, large cohort studies with accurate cardiac substructure (CS) contours are lacking, limiting our understanding of the potential influence of individual CSs. Here, we analyse the correlation between CS dose and overall survival (OS) while accounting for deep learning (DL) contouring uncertainty, a/b uncertainty and different modelling approaches. Materials/Methods: This single institution, retrospective cohort study includes 730 patients (early-stage tumours (I or II). All treated: 2009–2019), who received stereotactic body radiotherapy (≥5 Gy per fraction). A DL model was trained on 70 manually contoured patients to create 12 cardio-vascular structures. Structures with median dice score above 0.8 and mean surface distance (MSD) <2 mm during testing, were further analysed. Patientspecific CS dose was used to find the correlation between CS dose and OS with elastic net and random survival forest models (with and without confounding clinical factors). The influence of delineation-induced dose uncertainty on OS was investigated by expanding/contracting the DL-created contours using the MSD ± 2 standard deviations. Results: Eight CS contours met the required performance level. The left atrium (LA) mean dose was significant for OS and an LA mean dose of 3.3 Gy (in EQD2) was found as a significant dose stratum. Conclusion: Explicitly accounting for input parameter uncertainty in lung cancer survival modelling was crucial in robustly identifying critical CS dose parameters. Using this robust methodology, LA mean dose was revealed as the most influential CS dose parameter.

Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy for Non-Small Cell Lung Cancer Using Varian Ethos Therapy System

Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy for Non-Small Cell Lung Cancer Using Varian Ethos Therapy System

Ninety-day mortality following curative intent radiotherapy for stage I-III lung cancer in the Netherlands.

The 90-day mortality following lung cancer treatment is a common performance indicator. The aim of this study was to investigate 90-day mortality following (chemo)radiotherapy for stage I-III lung cancer to evaluate the applicability of this outcome indicator in this patient population. The Netherlands National Cancer Registry was queried for this retrospective population-based study. Early mortality rates from the start and end of radiotherapy are reported with 95% confidence intervals (CI). The association between clinical characteristics and 90-day mortality was evaluated with multivariable logistic regression analysis. 18,355 Patients treated between 2015-2020 were included. The 90-day mortality was 2.56% in stages I-II and 4.60% in stage III, was significantly higher in males, elderly patients and patients with a poor performance status and independent of facility volume. In stage I-II, 90-day mortality was lower after stereotactic versus conventional radiotherapy (2.0% versus 5.25%, OR 0.5 (95%CI 0.4-0.7)). In stage III, mortality decreased from 5.26% in 2015-2016 to 3.73% in 2019-2020 (OR 0.7 (95% CI 0.5-0.9)) and was lower after concurrent versus sequential chemoradiotherapy (3.4% versus 5.9%, OR 1.5 (95%CI 1.2-1.9)). Early mortality increased to 3.20% in stages I-II and 6.70% in stage III when calculated from the end of radiotherapy. Short-term mortality rates following curative intent radiotherapy for lung cancer in the Netherlands are low and independent of facility volume. It was demonstrated that 90-day mortality is an arguable indicator to monitor radiotherapy quality and that standardization of definitions and relevant case-mix factors is warranted.

Hypofractionated Radiation Therapy Suppresses Radioresistance in U87 Human Glioma Cells by Inhibiting Yap1 and Hsp90 Proteins.

Radiotherapy plays a vital role in the management of high-grade gliomas. However, the radio resistance of glioma cells limits the effect of radiation and drives recurrence inside the irradiated tumor volume leading to poor outcomes for patients. High-grade glioma cell radioresistance significantly contributes to radiotherapy failure, highlighting the importance of identifying predictive biomarkers for radioresistance. An increasing body of evidence complies with the Yes Associated Protein 1 (Yap-1) and heat shock protein 90 (Hsp90) as biomarkers for radioresistance in glioma cells. A number of studies suggest the potential of radioresistance-associated factors as biomarkers and/ or novel therapeutic targets in glioma cells. Thus, it is essential for glioblastoma patients to identify robust druggable targets involved in radioresistance, optimizing irradiation protocol, and understanding their underlying molecular mechanisms. Therefore, in the present study, we hypothesized that hypofractionated Gamma Knife radiation therapy (HF-GKRT) could target Yap-1 and Hsp90 and downregulate the mechanism of radioresistance in high-grade glioma cells. For this purpose, expression levels of radioresistance markers Yap-1 and Hsp90 were evaluated after treatment with HF-GKRT, and this was compared with single fraction Gamma Knife radiation therapy (SF-GKRT) in U87MG primary human glioblastoma cell line model. This would help design a novel radiation therapy regimen for glioblastoma patients by reducing the risk of radioresistance.

How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment

How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment

Improvement in cranial neuropathies following stereotactic radiotherapy as primary treatment for skull base meningiomas

Purpose Many patients with skull base meningiomas (SBMs) develop cranial neuropathies, though there is a paucity in literature regarding cranial neuropathy improvement following treatment. This is even more profound when isolating for patients who received stereotactic radiotherapy (SRT) as their primary treatment without additional open surgery. Our goal was to investigate the effect of SRT on cranial neuropathies secondary to SBMs and identify predictors of favourable treatment response. Materials and methods A single-center retrospective case-control study was performed assessing factors associated with cranial neuropathy improvement in patients with SBMs treated with SRT alone. Patients diagnosed with SBMs, having a cranial neuropathy, and treatment with radiation monotherapy were included. Patients without SBMs or who underwent surgery treatments were excluded. Patients with olfactory and vestibulocochlear neuropathies were ultimately excluded due to sample sizes. Subgroup analysis was performed assessing predictors of improvement for optic, extraocular, and trigeminal neuropathy. Statistical analysis was completed using R version 4.0 (R Foundation for Statistical Computing, Vienna, Austria). Results Eighty-five patients met the inclusion criteria of SBMs treated with SRT alone. Forty-five patients (52.9%) had improvement in their symptoms. Among the entire cohort, there was no significant difference between gender, age, tumour location, type of neuropathy, duration of symptoms, tumour volume, total radiation dose, or follow-up duration between those who did and those who did not improve. Subgroup analysis demonstrated significant improvement with younger age at diagnosis of optic neuropathy (50.7 vs 59.6 years, p = 0.04), shorter duration of symptoms prior to radiation in those with extraocular neuropathy (3.0 vs 11.5 months, p = 0.02), and lower radiation dose in those with trigeminal neuropathy (50.0 vs 54.0 Gy, p = 0.01). Conclusions This study demonstrates that SRT alone resulted in cranial neuropathy improvement in more than half of patients with SBM and identifies factors predictive of symptom resolution.

Long-term tumor control following gamma-knife radiosurgery of recurrent or residual pituitary adenomas: a population-based cohort study

BackgroundPituitary adenomas (PAs) often require adjuvant Gamma Knife radiosurgery (GKRS) due to partial resection or postoperative recurrence. The purpose of this study was to evaluate the long-term efficacy of GKRS for such cases.MethodsPopulation-based, observational cohort study of patients who underwent GKRS for postoperative residual or recurrent PAs between 1999 and 2020. We assessed long-term progression-free survival (PFS), identified predictors of tumor growth, and documented adverse radiation events (AREs).Results147 patients were included, with a median follow-up time of 8.1 years. Following GKRS, the 5-year and 10-year PFS was 86% and 68%, respectively, with a median PFS of 18.7 years. Somatotrophic adenomas showed a significantly lower risk of tumor progression in the regression analysis (OR 0.11, p = 0.003). Hypopituitarism was the most common ARE, affecting 32% of patients.ConclusionGKRS is an effective treatment option for recurrent or residual PAs, offering substantial long-term control. However, the risk for AREs, particularly hypopituitarism, is not negligeable.

Pterygopalatine Catecholamine-Secreting Paraganglioma: A Diagnostic and Therapeutic Challenge.

Paragangliomas are rare neuroendocrine tumors originating from the paraganglia. They are mostly benign, slow-growing, and non-secretory. This report describes a rare case of a catecholamine-secreting paraganglioma located in the pterygopalatine fossa. A 45-year-old man presented with severe hypertension, occipital headache, and facial pain. Imaging revealed a large pterygopalatine mass, initially misdiagnosed as chondrosarcoma. Gamma knife stereotactic radiosurgery was performed, followed by surgical resection via a maxillary swing approach. Histological examination confirmed the zellballen pattern typical of paraganglioma. Post-surgery, the patient's blood pressure normalized immediately and subsequently. This case highlights the diagnostic challenges of head and neck paragangliomas in atypical locations and underscores the importance of surgical intervention for catecholamine-secreting tumors. Future studies should focus on refining diagnostic protocols and comparing the efficacy of radiosurgery versus surgical resection for these tumors.

Gamma Knife radiosurgery for relapsing trigeminal neuralgia following microvascular decompression.

Gamma Knife radiosurgery (GKRS) is a treatment option for refractory trigeminal neuralgia (TN). However, there is a paucity of data regarding the effectiveness of GKRS for relapsing TN following microvascular decompression (MVD). The aim of this study was to characterize the response rate, complications, pain relief durability, and predictors of pain relapse for salvage GKRS following MVD for TN. A retrospective study of all patients who received GKRS for Burchiel type 1 TN (TN1) or type 2 TN (TN2) pain at Wake Forest University School of Medicine was conducted. Pain was measured using the Barrow Neurological Institute (BNI) pain intensity score. After an initial pain response of BNI scores I-III, a BNI score of IV or V constituted relapse. Durability of pain relief was characterized using the Kaplan-Meier estimator. Predictors of relapse were investigated using Cox regression models. Statistical significance was set at p < 0.05. Of 2065 patients with TN1 or TN2, 59 had GKRS post-MVD. Forty-nine (83.1%) of these patients experienced a BNI pain score of I-III at the first follow-up post-GKRS. The median time to relapse was 1.75 years; freedom rates from relapse were 77%, 45.9%, and 30.7% at 1, 2, and 5 years, respectively. Radiofrequency ablation prior to MVD significantly decreased the likelihood of an initial response to salvage GKRS (Fisher's exact test, p = 0.02). After controlling for baseline and clinical characteristics, facial numbness significantly decreased the likelihood of pain relapse (Cox regression, HR 0.15, 95% CI 0.03-0.73; p = 0.01). Conversely, a worse initial pain response significantly increased the likelihood of pain relapse (Cox regression, HR 3.64, 95% CI 1.02-12.95; p = 0.04). Pain relapse within 24 months of the original MVD did not predict durability of pain relief following salvage GKRS (Cox regression, HR 0.94, 95% CI 0.40-2.22; p = 0.89). The overall toxicity rate of salvage GKRS was 35.6%. Salvage GKRS presents an effective, noninvasive option for recurring TN after MVD, with a comparable response rate to primary GKRS or MVD, and a favorable complications profile relative to salvage MVD. Patients with postoperative facial numbness and a better initial pain response may experience more durable pain relief following salvage GKRS.

A predictive model for Gamma Knife intermediate dose spill: R50%Analytic-GK.

Minimizing intermediate dose spill in stereotactic radiosurgery (SRS) for brain treatment is crucial. Intermediate dose spill correlates with the exposure of normal brain tissue to high doses, which increases the risk of radionecrosis. R50%, defined as the volume of the 50% of prescription isodose cloud/planning target volume, is one metric for intermediate dose spill. A predictive model for R50% in linear accelerator VMAT-delivered SRS has been developed Desai etal. (2020) and is called R50%Analytic. This study extends the R50%Analytic model to Gamma Knife (GK) delivered SRS, resulting in the R50%Analytic-GK model. Phantom calculations were performed on 11 spherical target volumes ranging from 0.001 to 44cm3 to develop the R50%Analytic-GK model. R50%Analytic-GK was tested against clinical data from 18 brain metastasis cases with one to 11 targets treated on GK Icon and planned in GammaPlan with lightning dose optimizer. Thirty-five targets with volumes between 0.011 and 27.4cm3 were analyzed by extracting the R50% achieved clinically (R50%Clinical) for comparison to the predicted intermediate dose spill from R50%Analytic-GK. The predicted R50%Analytic-GK values generally represent a lower bound for the R50%Clinical values as the model would predict. The Difference, R50%Clinical - R50%Analytic-GK, has a median value of 0.92, which quantifies the lower bound nature of R50%Analytic-GK. The model reflected the character of intermediate dose spill for the clinical cases. A few outliers were likely due to specific planning complexities. The R50%Analytic-GK model for intermediate dose spill successfully extends the theoretical framework of R50%Analytic to GK-delivered SRS. It provides a method to predict the intermediate dose spill for GK Icon treatments. This model can aid in assessing SRS treatment plans by providing a benchmark for the intermediate dose spill for comparison.

The Effect of Upper Limbs on Dosage in Gamma Knife Treatment

The Effect of Upper Limbs on Dosage in Gamma Knife Treatment

Impact of stereotactic radiotherapy for craniopharyngioma: a large, academic hospital cohort.

Adjuvant radiotherapy has been a standard of care for craniopharyngioma. Nevertheless, it is a rare disease with multiple presentations, and results with conservative surgery followed by radiotherapy (RT) can vary. We compared treatment results for both adult and pediatric patients. This is a retrospective cohort of patients treated between 2010 and 2023 in a single university hospital. Seventy-nine patients' clinical data was assessed. Median follow-up was 75.5 months (7.1-210.2 months). Median age was 24.4 years, and 40 (50.6%) were considered pediatric patients. Median lesion size after surgery was 3.4 cm (range 0.4 to 10.4 cm). Ten patients (16.9%) were submitted to Ommaya reservoir placement surgery, and most (70%) have lesion reductions that impact radiotherapy planning. Timing of radiotherapy whether adjuvant or salvage did not impact progression-free survival (PFS) (p = 0.39). Median PFS was not reached, and mean PFS was 65.7 months. Disease control was obtained in 67 (84.1%) patients. We achieved great results with consisting institutional protocol in both adult and childhood craniopharyngioma. Timing of RT did not translate into loss of disease control in our study, with good results for salvage radiotherapy. Ommaya reservoirs can impact RT planning, but not outcomes.