Artikel
Stereotactic radiotherapy for the treatment of craniopharyngiomas
Stereotaktische Radiotherapie für die Behandlung von Kraniopharyngeomen
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Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Suprasellar located craniopharyngiomas are often cystic tumors affecting optical structures. Complete microsurgical removal is the treatment of choice, but the adherence to the chiasm and to the hypothalamic structures can make the surgery difficult with a high risk of postoperative complications. Incomplete tumor resections are associated with a higher recurrence rate. Stereotactic radiotherapy (SRT) can offer an additive or alternate treatment, especially for residual and recurrent tumors.
Methods: 26 consecutive craniopharyngiomas were treated with SRT within a 5-year period (2000-2005) in three centres (11 women and 15 men with a mean age of 49 years, range 5-80 years). 24 patients had undergone one or multiple previous surgery elsewhere and showed a progressive tumor growth. All 26 patients were treated with SRT in normal fractions of 1.8-2 Gy single dose up to 50-55.8 Gy (their irregular tumor volume ranged from 0.57 to 10.13 ccm, mean 3,5 ccm). 4 patients underwent a stereotactic cyst aspiration before and 3 in the first 3 months after SRT. Clinical results and the efficacy for tumor control were evaluated with a mean follow-up of 41 months (range 20-91months).
Results: Local tumor control rate was 100%. A tumor regression was proved in 19 cases (8 with a tumor shrinkage of more than 50%, the other 18 between 20% and 40%). Only in the first 3 months 4 patients had an increased cyst volume, two of them needed another cyst aspiration caused by the well known slow radiation effect. There were mild side effects according to CTC grade I in these both cases. 2 other patients suffered from mild headache temporarily, too. No patient got a new or increased neurological deficit. Improvement of one of the symptoms was found in 8 patients.
Conclusions: SRT is a very low risk and effective treatment option for craniopharyngiomas – particularly in residual and recurrent tumors SRT can be the treatment of choice. For each patient an interdisciplinary treatment strategy has to be found. In case of cystic tumors the combined stereotactic cyst aspiration followed by SRT proved to be an effective minimal invasive treatment option.