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- Spencer J Poiset, Andrew Song, In YoonHongHDepartment of Radiation Oncology, Yonsei University Health System, Seoul, South Korea., Jiayi Huang, Shray Jain, Joshua D Palmer, Jennifer K Matsui, Louis Cappelli, Jacob M Mazza, Ayesha S Ali, James J Evans, Christopher J Farrell, Kathryn N Kearns, Jason P Sheehan, and Wenyin Shi.
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
- World Neurosurg. 2024 Jul 1; 187: e852e859e852-e859.
ObjectiveTreatment of craniopharyngioma typically entails gross total resection (GTR) or subtotal resection with adjuvant radiation (STR-RT). We analyzed outcomes in adults with craniopharyngioma undergoing GTR versus STR-RT.MethodsThis retrospective study enrolled 115 patients with craniopharyngioma in 5 institutions. Patients with STR received postoperative RT with stereotactic radiosurgery or fractionated radiation therapy per institutional preference and ability to spare optic structures.ResultsMedian age was 44 years (range, 19-79 years). GTR was performed in 34 patients and STR-RT was performed in 81 patients with median follow-up of 78.9 months (range, 1-268 months). For GTR, local control was 90.5% at 2 years, 87.2% at 3 years, and 71.9% at 5 years. For STR-RT, local control was 93.6% at 2 years, 90.3% at 3 years, and 88.4% at 5 years. At 5 years following resection, there was no difference in local control (P = 0.08). Differences in rates of visual deterioration or panhypopituitarism were not observed between GTR and STR-RT groups. There was no difference in local control in adamantinomatous and papillary craniopharyngioma regardless of treatment. Additionally, worse local control was found in patients receiving STR-RT who were underdosed with fractionated radiation therapy (P = 0.03) or stereotactic radiosurgery (P = 0.04).ConclusionsGood long-term control was achieved in adults with craniopharyngioma who underwent STR-RT or GTR with no significant difference in local control. First-line treatment for craniopharyngioma should continue to be maximal safe resection followed by RT as needed to balance optimal local control with long-term morbidity.Copyright © 2024 Elsevier Inc. All rights reserved.
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