The superiority of conservative resection and adjuvant radiation for craniopharyngiomas

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• 作者：Adam Schoenfeld (1)
  Melike Pekmezci (2)
  Michael J. Barnes (2)
  Tarik Tihan (2)
  Nalin Gupta (34)
  Kathleen R. Lamborn (3)
  Anu Banerjee (4)
  Sabine Mueller (5)
  Susan Chang (3)
  Mitchel S. Berger (3)
  Daphne Haas-Kogan (13) dhaaskogan@radonc.ucsf.edu
• 关键词：Craniopharyngioma – ; Surgical resection – ; Radiation therapy – ; Adult – ; Pediatric
• 刊名：Journal of Neuro-Oncology
• 出版年：2012
• 出版时间：May 2012
• 年：2012
• 卷：108
• 期：1
• 页码：133-139
• 全文大小：335.9 KB
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• 作者单位：1. Department of Radiation Oncology, University of California, San Francisco (UCSF), 1600 Divisadero St. Suite H1031, San Francisco, CA 94143-1708, USA2. Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA3. Department of Neurosurgery, University of California, San Francisco (UCSF), San Francisco, CA, USA4. Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA5. Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

The purpose of this study is to evaluate the roles of resection extent and adjuvant radiation in the treatment of craniopharyngiomas. We reviewed the records of 122 patients ages 11–52 years who received primary treatment for craniopharyngioma between 1980 and 2009 at the University of California, San Francisco (UCSF). Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were development of panhypopituitarism, diabetes insipidus (DI), and visual field defects. Of 122 patients, 30 (24%) were treated with gross total resection (GTR) without radiation therapy (RT), 3 (3%) with GTR + RT, 41 (33.6%) with subtotal resection (STR) without RT, and 48 (39.3%) with STR + RT. Median age at diagnosis was 30 years, with 46 patients 18 years or younger. Median follow-up for all patients was 56.4 months (interquartile range 18.9–144.2 months) and 47 months (interquartile range 12.3–121.8 months) for the 60 patients without progression. Fifty six patients progressed, 10 have died, 6 without progression. Median PFS was 61.1 months for all patients. PFS rate at 2 years was 61.5% (95% CI: 52.1–70.9). OS rate at 10 years was 91.1% (95% CI 84.3–97.9). There was no significant difference in PFS and OS between patients treated with GTR vs. STR + XRT (PFS; p = 0.544, OS; p = 0.735), but STR alone resulted in significantly shortened PFS compared to STR + RT or GTR (p < 0.001 for both). STR was associated with significantly shortened OS compared to STR + RT (p = 0.050) and trended to shorter OS compared to GTR (p = 0.066). GTR was associated with significantly greater risk of developing DI (56.3 vs. 13.3% with STR + XRT, p < 0.001) and panhypopituitarism (54.8 vs. 26.7% with STR + XRT, p = 0.014). In conclusion, for patients with craniopharyngioma, STR + RT may provide superior clinical outcome, achieving better disease control than STR and limiting side effects associated with aggressive surgical resection.