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Optimizing stereotactic radiosurgery in patients with recurrent or residual craniopharyngiomas

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Abstract

Purpose

Stereotactic radiosurgery (SRS) is an important management strategy for residual and recurrent craniopharyngiomas. The current study evaluated the factors which affected tumor control and complications in craniopharyngioma SRS.

Methods

This study includes 53 consecutive patients who underwent single-session SRS for recurrent or residual craniopharyngiomas. The median age was 41 years with 28 male and 25 females. The median tumor volume was 0.63 cm3 and median margin dose was 12 Gy (range 9–25 Gy).

Results

The overall 3-, 5-, and 10-year survival rates were 97.8%, 92.7% and 88.5%. The overall 3-, 5-, and 10-year tumor control rates were 81.0%, 72.1%, and 53.4%. In univariate analysis, ≥ 3 mm distance from optic structures (p = 0.002), only solid or cystic tumor type (p = 0.037), and ≥ 12 Gy to ≥ 85% of the tumor (p < 0.001) were significantly associated with improved tumor control. In multivariate analysis, only solid or cystic tumor type, (p = 0.034), and ≥ 85% of the tumor receiving ≥ 12 Gy (p = 0.004) were significantly associated with better tumor control. When ≥ 85% of the tumor received ≥ 12 Gy the tumor control rates at 3-, 5-, and 10-year were 100%, 93.3%, and 93.3%. Higher conformity index was not associated with better tumor control.

Conclusions

The tumor control rates after recurrent or residual craniopharyngiomas SRS were improved by ensuring that at least 85% of the tumor received ≥ 12 Gy even when the distance between the tumor and the optic system is < 3 mm. This concept refutes the conformity theory that a high conformity index is a critical feature of effective SRS.

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Funding

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Akiyoshi Ogino, Ajay Niranjan, Hideyuki Kano & L. Dade Lunsford

  2. Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    John C. Flickinger

  3. Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Akiyoshi Ogino, Ajay Niranjan, Hideyuki Kano, John C. Flickinger & L. Dade Lunsford

  4. Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan

    Akiyoshi Ogino

Authors
  1. Akiyoshi Ogino
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  2. Ajay Niranjan
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  3. Hideyuki Kano
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  4. John C. Flickinger
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  5. L. Dade Lunsford
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Contributions

AO: Data collection, statistics, drafting and approval of final version of manuscript. AN: Review of data and statistics, critical review of manuscript and approval of the final version. HK: review of statistics, review and approval of final version of manuscript. JCF: Review and approval of final version of manuscript. LDL: Critical review and approval of final version of manuscript.

Corresponding author

Correspondence to Ajay Niranjan.

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Conflict of interest

Dr. Lunsford reported being a consultant for the Insightec Data and Safety Monitoring Board and an AB Elekta stockholder.

Ethical approval

This study (PITT_PRO_STUDY20010256) was reviewed and approved by Institutional Review Board of University of Pittsburgh.

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Ogino, A., Niranjan, A., Kano, H. et al. Optimizing stereotactic radiosurgery in patients with recurrent or residual craniopharyngiomas. J Neurooncol 154, 113–120 (2021). https://doi.org/10.1007/s11060-021-03806-7

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  • DOI: https://doi.org/10.1007/s11060-021-03806-7

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