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The role of fractionated radiotherapy and radiosurgery in the management of patients with craniopharyngioma

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Abstract

The optimal management of craniopharyngiomas remains controversial. The first-line treatment usually consists of surgical resection. Complete tumor removal provides a high rate of long-term control; however, aggressive surgery is associated with significant incidence of complications. Radiotherapy (RT) is currently used in patients after limited surgery and achieves excellent long-term tumor control. Stereotactic radiotherapy, both in the form of radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT), has been developed as a more accurate technique of irradiation with more precise tumor localization and consequently a reduction in the volume of normal brain irradiated to high radiation doses. We provide a review of published data on outcome of conventional fractionated RT and modern radiation techniques. FSRT is a suitable treatment technique for all sizes of craniopharyngiomas, and efficacy is comparable to conventional RT. Single-fraction stereotactic radiosurgery is usually delivered to small tumors away from critical structures. Longer follow-up is necessary to confirm the excellent tumor control and the potential reduction of long-term radiation toxicity.

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Authors and Affiliations

  1. Department of Radiotherapy Oncology, Sant’ Andrea Hospital, University “La Sapienza”, Via di Grottarossa 1035, 00189, Rome, Italy

    G. Minniti & R. Maurizi Enrici

  2. Department of Neurosurgical Sciences, Neuromed Institute, Pozzilli (IS), Italy

    G. Minniti & V. Esposito

  3. ATreP- Provincial Agency for Proton Therapy, Trento, Italy

    M. Amichetti

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  1. G. Minniti
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  2. V. Esposito
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  3. M. Amichetti
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  4. R. Maurizi Enrici
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Correspondence to G. Minniti.

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James Rutka, Toronto, Canada

The authors have provided a timely summary of radiation therapy strategies which can be employed in select cases of patients with craniopharyngiomas.

From the outset, it should be clear that this is a review article, and the opinions herein are derived from the authors’ interpretation of the results in the literature. In addition, the review is predominantly focused on the literature in adult patients, and so extrapolation to the use of radiation therapy for children with craniopharyngiomas should be undertaken cautiously.

The authors describe the use of conventional radiation therapy, radiosurgery, and fractionated SRS. Toward the end, they also discuss the role of proton beams as a radiation treatment source for craniopharyngioma. This latter technique has not been employed to the same degree as the other radiation therapy strategies at this point.

The value of this review article is readily apparent upon perusing the tables which summarize the main published studies on the role of radiation therapy in craniopharyngioma. Here, one sees that conventional radiation therapy has a 75–80% long-term control rate with a variable number of complications. Of course, the complication that should be accurately identified here is cognitive morbidity from radiation therapy to this region. With the exception of the report by Kobayashi et al. [22], most of the series in which gamma knife radiosurgery has been used have been relatively small in terms of numbers of patients treated. Here, the safe dose of delivery is 8–10 Gy. Complications are few, but tumor control is a bit more variable. The early reports of fractionated stereotactic radiotherapy are encouraging as experience grows.

I commend the authors for providing the readership with a thorough review of the literature on the topic of craniopharyngioma. As craniopharyngioma remains a tumor providing physicians and surgeons with numerous treatment options, it is useful to have the information on radiation delivery strategies in one review such as this.

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Minniti, G., Esposito, V., Amichetti, M. et al. The role of fractionated radiotherapy and radiosurgery in the management of patients with craniopharyngioma. Neurosurg Rev 32, 125–132 (2009). https://doi.org/10.1007/s10143-009-0186-4

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