International Journal of Radiation Oncology*Biology*Physics
Clinical investigationBrainCombined proton and photon irradiation for craniopharyngioma: Long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital
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
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Funded in part by National Institute of Health Grant No. PO1 CA 21239.