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Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients

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Abstract

This paper summarizes outcomes of a single-center study of intracavitary brachytherapy (IBT) with stereotactically applied phosphorus-32 (32P) colloid for treatment of cystic craniopharyngiomas. We assessed its efficacy and safety, on the basis of clinical and radiological outcomes in one of the largest reported patient series. Between 1992 and 2011, 53 patients were treated with IBT, 14 without previous treatment and 39 who had previously been treated for recurrent cysts. Intervention was performed by applying 200 Gy to the internal cyst wall (median volume 6.1 ml). Median clinical and radiological follow-up were 60.2 and 53.0 months, respectively. Actuarial tumor cyst control was 86.0 ± 5.3 % at 12, 24, and 60 months. Actuarial out-of-field control (development of new cysts or progression of solid tumor parts) was 90.9 ± 4.3, 84.0 ± 5.6, and 54.5 ± 8.8 % after 12, 24, and 60 months, respectively. Corresponding actuarial overall progression-free survival was 79.4 ± 6.1, 72.4 ± 6.8, and 45.6 ± 8.7 % at 12, 24, and 60 months, respectively. Visual function improved for 12 patients (23.5 %), remained unchanged for 34 patients (66.7 %), and worsened for five patients (9.8 %), correlating with tumor progression in each case. Endocrinological deterioration occurred for ten patients (19.6 %); for nine patients this was a result of tumor progression or after tumor resection and for one it was attributed to irradiation. Within six months of IBT seven patients (13.7 %) experienced transient neurological deficits and two patients (3.9 %) deteriorated permanently (hemiparesis and third nerve palsy). Stereotactically applied 32P is highly efficacious for control of cystic components of craniopharyngiomas and is associated with a low risk of permanent morbidity. The procedure does not, however affect the development of new cysts or the progression of solid tumor parts.

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References

  1. Karavitaki N, Cudlip S, Adams CB, Wass JA (2006) Craniopharyngiomas. Endocr Rev 27(4):371–397

    Article  PubMed  Google Scholar 

  2. Muller HL (2011) Consequences of craniopharyngioma surgery in children. J Clin Endocrinol Metab 96(7):1981–1991

    Article  PubMed  Google Scholar 

  3. Komotar RJ, Roguski M, Bruce JN (2009) Surgical management of craniopharyngiomas. J Neurooncol 92(3):283–296

    Article  PubMed  Google Scholar 

  4. Zuccaro G (2005) Radical resection of craniopharyngioma. Childs Nerv Syst 21(8–9):679–690

    Article  PubMed  Google Scholar 

  5. Kawamata T, Amano K, Aihara Y, Kubo O, Hori T (2010) Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities. Neurosurg Rev 33(1):71–81

    Article  PubMed  Google Scholar 

  6. Marchal JC, Klein O, Thouvenot P, Bernier V, Moret C, Chastagner P (2005) Individualized treatment of craniopharyngioma in children: ways and means. Childs Nerv Syst 21(8–9):655–659

    Article  PubMed  CAS  Google Scholar 

  7. Thompson D, Phipps K, Hayward R (2005) Craniopharyngioma in childhood: our evidence-based approach to management. Childs Nerv Syst 21(8–9):660–668

    Article  PubMed  Google Scholar 

  8. Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O, Shine B, Turner HE, Wass JA (2005) Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol (Oxf) 62(4):397–409

    Article  CAS  Google Scholar 

  9. Choux M, Lena G, Genitori L (1991) Craniopharyngioma in children. Neurochirurgie 37(Suppl 1):1–174

    Google Scholar 

  10. Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89(4):547–551

    Article  PubMed  CAS  Google Scholar 

  11. Kiehna EN, Merchant TE (2010) Radiation therapy for pediatric craniopharyngioma. Neurosurg Focus 28(4):E10

    Article  PubMed  Google Scholar 

  12. Yang I, Sughrue ME, Rutkowski MJ, Kaur R, Ivan ME, Aranda D, Barani IJ, Parsa AT (2010) Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 28(4):E5

    Article  PubMed  Google Scholar 

  13. Sughrue ME, Yang I, Kane AJ, Fang S, Clark AJ, Aranda D, Barani IJ, Parsa AT (2011) Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 101(3):463–476

    Article  PubMed  Google Scholar 

  14. Backlund EO (1994) Treatment of craniopharyngiomas: the multimodality approach. Pediatr Neurosurg 21(Suppl 1):82–89

    Article  PubMed  Google Scholar 

  15. Leksell L, Liden K (1952) A therapeutic trial with radioactive isotopes in cystic brain tumours. Radioisotope techniques. J Med Physiol Appl 4:1–4

    Google Scholar 

  16. Van den Berge JH, Blaauw G, Breeman WA, Rahmy A, Wijngaarde R (1992) Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 77(4):545–550

    Article  PubMed  Google Scholar 

  17. Berenger N, Lebtahi R, Piketty M, Munari C, Merienne L, Turak B, Bok R, Askienazy S (1993) Endocavitary treatment of craniopharyngioma cysts by 186-rhenium [in French]. Médecine Nucléaire 17:120–128

    Google Scholar 

  18. Pollock BE, Lunsford LD, Kondziolka D, Levine G, Flickinger JC (1995) Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys 33(2):437–446

    Article  PubMed  CAS  Google Scholar 

  19. Voges J, Sturm V, Lehrke R, Treuer H, Gauss C, Berthold F (1997) Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery 40(2):263–269; discussion 269–270

    Google Scholar 

  20. Hasegawa T, Kondziolka D, Hadjipanayis CG, Lunsford LD (2004) Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 54(4):813–820; discussion 820–812

    Google Scholar 

  21. Julow J, Backlund EO, Lanyi F, Hajda M, Balint K, Nyary I, Szeifert GT (2007) Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas. Neurosurgery 61(2):288–295; discussion 295–286

    Google Scholar 

  22. Derrey S, Blond S, Reyns N, Touzet G, Carpentier P, Gauthier H, Dhellemmes P (2008) Management of cystic craniopharyngiomas with stereotactic endocavitary irradiation using colloidal 186Re: a retrospective study of 48 consecutive patients. Neurosurgery 63(6):1045–1052; discussion 1052–1043

    Google Scholar 

  23. Blackburn TP, Doughty D, Plowman PN (1999) Stereotactic intracavitary therapy of recurrent cystic craniopharyngioma by instillation of 90yttrium. Br J Neurosurg 13(4):359–365

    Article  PubMed  CAS  Google Scholar 

  24. Janicki C, Seuntjens J (2003) Re-evaluation of the dose to the cyst wall in P-32 radiocolloid treatments of cystic brain tumors using the dose-point-kernel and Monte Carlo methods. Med Phys 30(9):2475–2481

    Article  PubMed  CAS  Google Scholar 

  25. Sturm V, Pastyr O, Schlegel W, Scharfenberg H, Zabel HJ, Netzeband G, Schabbert S, Berberich W (1983) Stereotactic computer tomography with a modified Riechert–Mundinger device as the basis for integrated stereotactic neuroradiological investigations. Acta Neurochir (Wien) 68(1–2):11–17

    Article  CAS  Google Scholar 

  26. Treuer H, Klein D, Maarouf M, Lehrke R, Voges J, Sturm V (2005) Accuracy and conformity of stereotactically guided interstitial brain tumour therapy using I-125 seeds. Radiother Oncol 77(2):202–209

    Article  PubMed  Google Scholar 

  27. Strauss L, Sturm V, Georgi P, Schlegel W, Ostertag H, Clorius JH, van Kaick G (1982) Radioisotope therapy of cystic craniopharyngomas. Int J Radiat Oncol Biol Phys 8(9):1581–1585

    Article  PubMed  CAS  Google Scholar 

  28. Ende G, Treuer H, Boesecke R (1992) Optimization and evaluation of landmark-based image correlation. Phys Med Biol 37(1):261–271

    Article  PubMed  CAS  Google Scholar 

  29. Loevinger R (1954) The dosimetry of beta radiations. Radiology 62(1):74–82

    PubMed  CAS  Google Scholar 

  30. Barriger RB, Chang A, Lo SS, Timmerman RD, DesRosiers C, Boaz JC, Fakiris AJ (2011) Phosphorus-32 therapy for cystic craniopharyngiomas. Radiother Oncol 98(2):207–212

    Article  PubMed  CAS  Google Scholar 

  31. Albright AL, Hadjipanayis CG, Lunsford LD, Kondziolka D, Pollack IF, Adelson PD (2005) Individualized treatment of pediatric craniopharyngiomas. Childs Nerv Syst 21(8–9):649–654

    Article  PubMed  Google Scholar 

  32. Samii M, Tatagiba M (1997) Surgical management of craniopharyngiomas: a review. Neurol Med Chir (Tokyo) 37(2):141–149

    Article  CAS  Google Scholar 

  33. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90(2):237–250

    Article  PubMed  CAS  Google Scholar 

  34. Van Effenterre R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97(1):3–11

    Article  PubMed  Google Scholar 

  35. Tomita T, Bowman RM (2005) Craniopharyngiomas in children: surgical experience at Children’s Memorial Hospital. Childs Nerv Syst 21(8–9):729–746

    Article  PubMed  Google Scholar 

  36. Steinbok P, Hukin J (2010) Intracystic treatments for craniopharyngioma. Neurosurg Focus 28(4):E13

    Article  PubMed  Google Scholar 

  37. Park DH, Park JY, Kim JH, Chung YG, Lee HK, Lee KC, Suh JK (2002) Outcome of postoperative intratumoral bleomycin injection for cystic craniopharyngioma. J Korean Med Sci 17(2):254–259

    PubMed  CAS  Google Scholar 

  38. Hukin J, Steinbok P, Lafay-Cousin L, Hendson G, Strother D, Mercier C, Samson Y, Howes W, Bouffet E (2007) Intracystic bleomycin therapy for craniopharyngioma in children: the Canadian experience. Cancer 109(10):2124–2131

    Article  PubMed  CAS  Google Scholar 

  39. Mottolese C, Stan H, Hermier M, Berlier P, Convert J, Frappaz D, Lapras C (2001) Intracystic chemotherapy with bleomycin in the treatment of craniopharyngiomas. Childs Nerv Syst 17(12):724–730

    Article  PubMed  CAS  Google Scholar 

  40. Zanon N (1998) Craniopharyngiomas: intratumoral chemotherapy with bleomycin in children and adolescents. Arq Neuropsiquiatr 56:859

    Article  Google Scholar 

  41. Linnert M, Gehl J (2009) Bleomycin treatment of brain tumors: an evaluation. Anticancer Drugs 20(3):157–164

    Article  PubMed  CAS  Google Scholar 

  42. Cavalheiro S, Dastoli PA, Silva NS, Toledo S, Lederman H, da Silva MC (2005) Use of interferon alpha in intratumoral chemotherapy for cystic craniopharyngioma. Childs Nerv Syst 21(8–9):719–724

    Article  PubMed  CAS  Google Scholar 

  43. Cavalheiro S, Di Rocco C, Valenzuela S, Dastoli PA, Tamburrini G, Massimi L, Nicacio JM, Faquini IV, Ierardi DF, Silva NS, Pettorini BL, Toledo SR (2010) Craniopharyngiomas: intratumoral chemotherapy with interferon-alpha: a multicenter preliminary study with 60 cases. Neurosurg Focus 28(4):E12

    Article  PubMed  Google Scholar 

  44. Dastoli PA, Nicacio JM, Silva NS, Capellano AM, Toledo SR, Ierardi D, Cavalheiro S (2011) Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon. Arq Neuropsiquiatr 69(1):50–55

    Article  PubMed  Google Scholar 

  45. Ierardi DF, Fernandes MJ, Silva IR, Thomazini-Gouveia J, Silva NS, Dastoli P, Toledo SR, Cavalheiro S (2007) Apoptosis in alpha interferon (IFN-alpha) intratumoral chemotherapy for cystic craniopharyngiomas. Childs Nerv Syst 23(9):1041–1046

    Article  PubMed  CAS  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Philipp Kickingereder, Mohammad Maarouf, Faycal El Majdoub, Manuel Fuetsch, Jochen Wirths, Klaus Luyken, Harald Treuer & Volker Sturm

  2. Department of Stereotactic Neurosurgery, St. Barbara Hospital, Hamm, Germany

    Ralph Lehrke

  3. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany

    Klaus Schomaecker

  4. Department of Stereotactic Neurosurgery, University Hospital of Magdeburg, Magdeburg, Germany

    Juergen Voges

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  1. Philipp Kickingereder
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  4. Manuel Fuetsch
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Correspondence to Mohammad Maarouf.

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P. Kickingereder and M. Maarouf contributed equally to this study.

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Kickingereder, P., Maarouf, M., El Majdoub, F. et al. Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients. J Neurooncol 109, 365–374 (2012). https://doi.org/10.1007/s11060-012-0902-8

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