Radiosurgery for Craniopharyngioma

Niranjan, Ajay; Kano, Hideyuki; Mathieu, David; Kondziolka, Douglas; Flickinger, John C.; Lunsford, L. Dade

doi:10.1016/j.ijrobp.2009.07.1693

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 78, Issue 1 , Pages 64-71, 1 September 2010

Radiosurgery for Craniopharyngioma

Ajay Niranjan, M.S., M.Ch.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Reprint requests to: Ajay Niranjan, M.S., M.Ch., Department of Neurosurgery, University of Pittsburgh School of Medicine, Suite B-400, University of Pittsburgh Medical Center Presbyterian, 200 Lothrop St., Pittsburgh, PA 15213. Tel: (412) 647-9699; Fax: (412) 647-8447
Hideyuki Kano, M.D., Ph.D.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
David Mathieu, M.D.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
Douglas Kondziolka, M.D., M.Sc.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
John C. Flickinger, M.D.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
L. Dade Lunsford, M.D.
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Received 8 January 2009; received in revised form 2 July 2009; accepted 10 July 2009. published online 14 December 2009.

Purpose

To analyze the outcomes of gamma knife stereotactic radiosurgery (SRS) for residual or recurrent craniopharyngiomas and evaluate the factors that optimized the tumor control rates.

Methods and Materials

A total of 46 patients with craniopharyngiomas underwent 51 SRS procedures at University of Pittsburgh between 1988 and 2007. The median tumor volume was 1.0 cm³ (range, 0.07–8.0). The median prescription dose delivered to the tumor margin was 13.0 Gy (range, 9–20). The median maximal dose was 26.0 Gy (range, 20–50). The mean follow-up time was 62.2 months (range, 12–232).

Results

The overall survival rate after SRS was 97.1% at 5 years. The 3- and 5-year progression-free survival rates (solid tumor control) were both 91.6%. The overall local control rate (for both solid tumor and cyst control) was 91%, 81%, and 68% at 1, 3, and 5 years, respectively. No patients with normal pituitary function developed hypopopituitarism after SRS. Two patients developed homonymous hemianopsia owing to tumor progression after SRS. Among the factors examined, complete radiosurgical coverage was a significant favorable prognostic factor.

Conclusion

SRS is a safe and effective minimally invasive option for the management of residual or recurrent craniopharyngiomas. Complete radiosurgical coverage of the tumor was associated with better tumor control.

Craniopharyngioma, stereotactic radiosurgery, gamma knife, dose planning