Clinical investigation
Brain
Combined proton and photon irradiation for craniopharyngioma: Long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital

Presented in part at the Radiological Society of North America Annual Meeting, Chicago 2000.
https://doi.org/10.1016/j.ijrobp.2005.09.034Get rights and content

Purpose: We report the results of the early cohort of patients treated for craniopharyngioma with combined proton-photon irradiation at the Massachusetts General Hospital and the Harvard Cyclotron Laboratory.

Methods and Materials: Between 1981 and 1988, 15 patients with craniopharyngioma were treated in part or entirely with fractionated 160 MeV proton beam therapy. The group consisted of 5 children (median age, 15.9 years) and 10 adults (median age, 36.2 years). Median dose prescribed to the tumor was 56.9 cobalt Gray equivalent (CGE; 1 proton Gray = 1.1 CGE). The median proton component was 26.9 CGE. Patients were treated after documented recurrence after initial surgery (n = 6) or after subtotal resection or biopsy (n = 9). None had had prior radiation therapy.

Results: Median observation period of surviving patients (n = 11) was 13.1 years from radiotherapy. One patient was lost to follow-up with tumor control after 5.2 years. Actuarial 10-year survival rate was 72%. Four patients have died 5–9.1 years after treatment, two from local failure. Actuarial 5- and 10-year local control rates were 93% and 85%, respectively. The functional status of the living adult patients is unaltered from their preradiotherapy status; all of them continued leading normal or near normal working lives. None of the patients treated as a child had experienced recurrence of tumor. One child shows learning difficulties and slight retardation, comparable to his preradiotherapy status. The others have professional achievements within the normal range.

Conclusion: Results in terms of survival and local control are comparable with other contemporary series. Although no formal neuropsychological testing was performed, the surrogate measures of lifestyle and professional accomplishments appear to be satisfactory.

Introduction

Craniopharyngiomas are tumors that arise from remnants of Rathke’s pouch. Because of their central location in the sellar and suprasellar region, they may cause blindness, permanent hormonal insufficiency, or death, although they are histologically benign. These tumors most commonly present in childhood or young adult life. If incompletely resected, their local recurrence rate is high, in which case adjuvant radiotherapy has been used successfully to improve local control rates. If local tumor control can be achieved, the life expectancy of these patients is long. Thus it is of considerable interest to minimize long-term sequelae of radiotherapy. Fractionated studies of the superior dose localization properties of fractionated proton beam therapy in human tumors have been ongoing since 1975 in a fruitful collaboration between the Radiation Oncology Department of Massachusetts General Hospital and the Harvard Cyclotron Laboratory. We report here results in an early cohort of craniopharyngioma patients treated between 1981 and 1988 as part of that program.

Section snippets

Patient population and prior treatment

Fifteen patients with craniopharyngioma have been treated entirely or in part with computed tomography–planned three-dimensional conformal fractionated proton therapy in a collaborative program between the Radiation Oncology Department of Massachusetts General Hospital and the Harvard Cyclotron Laboratory between 1981 and 1988. The patients ranged in age from 8.2 to 53.2 years, with a median of 31.2 years. There were 5 children with a median age of 15.9 years (range, 8.2–16.8 years; 4 boys and

Survival and local control

The actuarial 5- and 10-year survival rates are 93% and 72%, respectively (Fig. 2). One patient was lost to follow-up with tumor controlled 5.2 years after treatment. She had hypertension and an extensive history of nicotine abuse at the time of presentation and continued to smoke during and after the treatment. She had sustained a stroke at age 58, with resultant incomplete hemiparesis and was censored at the time of last follow-up. Median observation period of patients alive (n = 10),

Discussion

Although complete surgical removal remains the principal curative approach to craniopharyngioma, this is not always feasible with acceptable toxicity (14, 15). Thus, in the situation of residual or recurrent tumor, adjuvant radiotherapy has achieved comparable control rates to radical surgery (16, 17, 18, 19). The toxicity of each approach is different. Whereas effects of surgery are usually acute “all or nothing effects,” sequelae of radiotherapy tend to have a probabilistic nature and occur

References (26)

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Funded in part by National Institute of Health Grant No. PO1 CA 21239.

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