Abstract
Although Craniopharyngiomas are histologically benign, the resulting clinical sequelae can be severe because of their proximity to the critical surrounding structures. Stereotactic radiosurgery (SRS) has been emerging as a valuable adjuvant therapy for residual or recurrent craniopharyngiomas. This retrospective study aims to provide an overview of the long-term results of modern SRS for craniopharyngiomas.
A total of 51 consecutive patients with residual or recurrent craniopharyngiomas underwent SRS consistently using Gamma Knife Model C or Perfexion from August 2002 to December 2012. The median age was 44 years and 30 men and 21 women were included in the study. Of those, 6 patients had undergone prior radiotherapy. The median tumor volume was 1.0 ml (range, 0.1-13.9) and there were 25 solid, 16 cystic and 14 mixed-type tumors. The median prescription dose delivered to the tumor margin was 12Gy (range, 10-18). Median maximal dose to the anterior visual pathways was 9.6Gy. Overall survival and local and remote recurrence rates were analyzed.
The median follow-up time was 71 months (range, 1-144). The overall survival rate after SRS was 92% at 5 years. Local control failure occurred in 16 tumors and the 3- and 5-year local control rates were 88% and 67%, respectively. Remote recurrence occurred in 6 patients and the 5-year remote recurrence rate was 11%. The 3- and 5-year progression-free survival rates were 80% and 63%, respectively. 18 patients (35%) needed subsequent interventions. Six patients suffered aggravated visual functions owing to tumor progression after SRS but none of the patients developed radiation induced optic neuropathy. Two patients developed new-onset diabetes insipidus. Multivariate analysis showed that prior radiotherapy and tumors with a cystic component were the predictive factors for a higher rate of local recurrence.
The present study suggested that Gamma Knife SRS could provide acceptable control of recurrent or residual craniopharyngiomas with low complication profiles in long-term follow-up.
