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Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma

  • Original Article - Brain Tumors
  • Published:
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Abstract

Objective

Radiation therapy is often advocated for residual or recurrent craniopharyngioma following surgical resection to prevent local recurrence. However, radiation therapy is not always effective and may render tumors more difficult to remove. If this is the case, patients may benefit more from reoperation if gross total resection can be achieved. Nevertheless, there is little data on the impact of radiation on reoperations for craniopharyngioma. In this study, we sought to analyze whether a history of previous radiation therapy (RT) affected extent of resection in patients with recurrent craniopharyngiomas subsequently treated with reoperation via endoscopic endonasal approach (EEA).

Methods

The authors reviewed a prospectively acquired database of EEA reoperations of craniopharyngiomas over 13 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior author. The operations were separated into two groups based on whether the patient had surgery alone (group A) or surgery and RT (group B) prior to recurrence.

Results

A total of 24 patients (16 male, 8 female) who underwent surgery for recurrent craniopharyngioma were identified. The average time to recurrence was 7.64 ± 4.34 months (range 3–16 months) for group A and 16.62 ± 12.1 months (range 6–45 months) for group B (p < 0.05). The average tumor size at recurrence was smaller in group A (1.85 ± 0.72 cm; range 0.5–3.2) than group B (2.59 ± 0.91 cm; range 1.5–4.6; p = 0.00017). Gross total resection (GTR) was achieved in 91% (10/11) of patients in group A and 54% (7/13) of patients in group B (p = 0.047). There was a near significant trend for higher average Karnofsky performance status (KPS) score at last follow-up for group A (83 ± 10.6) compared with group B (70 ± 16.3, p = 0.056).

Conclusions

While RT for residual or recurrent craniopharyngioma may delay time to recurrence, ability to achieve GTR with additional surgery is reduced. In the case of recurrent craniopharyngioma, if GTR can be achieved, consideration should be given to endonasal reoperation prior to the decision to irradiate residual or recurrent tumor.

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Abbreviations

RT:

Radiotherapy

EEA:

Endonasal endoscopic approach

GTR:

Gross total resection

STR:

Subtotal resection

KPS:

Karnofsky performance status

BMI:

Body mass index

CSF:

Cerebrospinal fluid

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Author information

Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Iyan Younus

  2. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jonathan A. Forbes

  3. Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogota, Colombia

    Edgar G. Ordóñez-Rubiano

  4. Department of Neurosurgery, Centro Médico Nacional, ISSSTE, Mexico City, Mexico

    Rafael Avendano-Pradel

  5. Foundation IRCCS Neurological Institute Carlo Besta, University of Milan and Department of Neurosurgery, Milan, Italy

    Emanuele La Corte

  6. Department of Otolaryngology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Vijay K. Anand & Theodore H. Schwartz

  7. Department of Neurosurgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Theodore H. Schwartz

  8. Department of Neuroscience, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Theodore H. Schwartz

  9. Departments of Neurological Surgery, Otolaryngology and Neuroscience, Department of Neurosurgery, Anterior Skull Base and Pituitary Surgery, Epilepsy Research Laboratory, Weill Cornell Medicine, 525 East 68th St., Box no. 99, New York, NY, 10065, USA

    Theodore H. Schwartz

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  1. Iyan Younus
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Correspondence to Theodore H. Schwartz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Younus, I., Forbes, J.A., Ordóñez-Rubiano, E.G. et al. Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma. Acta Neurochir 160, 1425–1431 (2018). https://doi.org/10.1007/s00701-018-3567-z

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  • DOI: https://doi.org/10.1007/s00701-018-3567-z

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