Aradhana Kaushal MD, Presenter: Nothing to Disclose

James J. Evans, Abstract Co-Author: Nothing to Disclose

Dwight E. Heron MD, Abstract Co-Author: Nothing to Disclose

Peter Savino, Abstract Co-Author: Nothing to Disclose

Walter J. Curran MD, Abstract Co-Author: Nothing to Disclose

David Wallace Andrews MD, Abstract Co-Author: Nothing to Disclose

Maria Werner-Wasik MD, Abstract Co-Author: Stockholder, Genentech, Inc

Sun Ha Paek, Abstract Co-Author: Nothing to Disclose

Molly Gilbert, Abstract Co-Author: Nothing to Disclose

Marc Rosen, Abstract Co-Author: Nothing to Disclose

Beverly Downes, Abstract Co-Author: Nothing to Disclose

Gregory Bednarz, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The authors retrospectively analyzed the outcomes of patients treated with fractionated stereotactic radiotherapy (FSR) for craniopharyngioma, either after surgery as an integrated approach for residual tumor or for patients referred for treatment of recurrent tumor.

After IRB approval, chart and radiographic review were initiated to assess treatment-related morbidities and outcomes which included tumor control, visual outcome and pituitary function.

Twenty-seven patients completed FSR and post-FSR MR imaging demonstrated complete response in 3 patients, partial response in 8 patients, and stable disease in 9 patients. Excluding cyst formation which required one or a limited number of drainage procedures without further intervention, we documented one solid asymptomatic recurrence at 7 years for a tumor control rate of 96% (26/27). Of the 11 patients with formal pre-and post-treatment Humphrey’s Visual Field testing, 8 had visual field defects prior to therapy. Of these, 6 patients improved significantly, suggesting that the combined approach of surgery and post-operative FSR is beneficial to visual field status in patients with craniopharyngioma. Of 17 patients who had endocrine dysfunction prior to FSR, 14 had stable function that required no additional hormone replacement therapy, 2 had resolution of hypopituitarism, and one patient required further hormone replacement therapy.

FSR for residual or recurrent craniopharyngiomas resulted in outcomes comparable to other radiotherapy modalities reported in the literature with low incidence of late sequelae. The combined modality of resection followed by initial planned post-operative radiation therapy also suggests improved visual and endocrine outcomes. The timing of the radiation therapy post-operatively appears to be important because of the observed high rate of recurrence for residual craniopharyngiomas. For this reason, FSR should be initiated as soon as it is feasible.

The combination of a minimally invasive image-guided endoscopic trans-nasal approach followed by FSR represents an integrated management of craniopharyngiomas to maximize the likelihood of cure.

Kaushal, A, Evans, J, Heron, D, Savino, P, Curran, W, Andrews, D, Werner-Wasik, M, Paek, S, Gilbert, M, Rosen, M, Downes, B, Bednarz, G, et al, , et al, , Integration of Surgery with Fractionated Stereotactic Radiotherapy (FSR) for the Treatment of Residual or Recurrent Craniopharyngiomas.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006155.html