Visual and Endocrine Function for Adult Craniopharyngiomas Treated with Radiation

Background: Craniopharyngiomas (CP) have bimodal distribution, with peaks at 0 to 19 and 40 to 59 years old. Although relatively indolent, disabling symptoms and sequelae can occur before and after treatment, including visual disturbances and hormonal dysfunction. We evaluated clinical outcomes and complications with adjuvant/salvage radiation treatment (XRT) for adult CP patients.

Materials and Methods: We conducted a multi-institutional retrospective study of adult craniopharyngiomas (≥18 years old at the time of diagnosis) who received adjuvant/salvage XRT. We collected age, gender, surgical approach, number, and types of treatment pre-XRT, XRT type/dose/fractionation, XRT treatment volume, pre-/post-XRT endocrine and visual function, recurrence, and survival. We performed Kaplan–Meier analyses for overall survival (OS) and progression-free survival (PFS). We also performed univariate and multivariate analysis with Cox proportional hazards model. Statistical analysis was performed on R version 3.5.1.

Results: A total of 54 patients (28 males, 26 females) were included from our institutions. Median age at the time of initial treatment was 41 years old (range: 18–78 years). Median follow-up time was 53.5 months (range: 7–195 months). Surgical information pre-XRT was available for 39 patients, with endoscopic resection being most common (21 patients, 53.8%). The rest had craniotomy resection (13, 33.3%), and craniofacial resection (5, 12.8%). Tumor composition was available for 45 patients, of which the majority were mixed solid-cystic with 25 patients (55.6%), 12 (26.7%) were solid, and 8 (17.8%) were cystic. Twenty-seven patients received fractionated stereotactic radiation therapy (FSRT) and 27 received Gamma Knife Stereotactic Radiosurgery (GK-SRS). Median margin dose for GK-SRS was 15 Gy (6–25 Gy) with a median treatment volume of 1.8 cc (0.2–16.2 cc). For FSRT, median dose was 54 Gy in 1.8 Gy per fraction (50.4–54 Gy) with a median treatment volume of 2.6 cc (0.6–125.5 cc). The local recurrence for FSRT patients was 18.5%, and 44.4% for GK-SRS patients. OS rates for all patients at 1, 2, and 5 years were 98.1, 95.9, 83.5%, respectively. Local control rates for all patients at 1, 2, and 5 years were 92.6, 86.2, and 78.2%, respectively. PFS rates at 1, 2, and 5 years were 92.6, 88.6, and 75.9%, respectively. For GK-SRS, PFS rates at 1, 2, and 5 years were 88.9, 80.5, and 59.5%, respectively. On multivariate analysis, endoscopic resection had less recurrence rate compared with craniofacial (p = 0.038), while P-32 injection pre-XRT was found to be worse for recurrence (p = 0.004). Majority of patients had pre-XRT endocrine (76%) and visual dysfunction (67.3%). Function was stable and/or improved in most patients post-XRT, with 15.9% of patients having worse endocrine function, and 8.3% of patients with worse vision. The rest had stable or improved function.

Conclusion: Adult CP treated with surgical resection and adjuvant/salvage XRT has majority of patients with stable and/or improved visual and endocrine function.

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