Artikel
Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for the treatment of cystic craniopharyngiomas
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Autoren
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P. Kickingereder
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
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M. Maarouf
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
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F.E. Majdoub
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
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M. Fuetsch
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
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R. Lehrke
- Klinik für Stereotaktische Neurochirurgie, St. Barbara Krankenhaus, Hamm
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H. Treuer
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
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J. Voges
- Klinik für Stereotaktische Neurochirurgie, Universität Magdeburg, Deutschland
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V. Sturm
- Klinik für Stereotaktische und Funktionelle Neurochirurgie, Universität Köln
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: The presented single-centre study summarizes the outcome after intracavitary brachytherapy (IBT) using stereotactically applied phosphorus-32 (32P) colloid for the treatment of cystic craniopharyngiomas. We assessed its efficacy and safety, based on tumor control and endocrinological, ophthalmological, and neurological outcomes in one of the largest reported patient series.
Methods: Between April 1992 and January 2011, 53 patients (including 19 children aged < 20 y) with 56 cysts were treated with IBT-14 had no prior treatment and 39 had been treated for recurrent cysts. The intervention was performed by applying 200 Gy (median, range: 200–250 Gy) to the internal cyst wall (median volume 6.1 ml). The median clinical and radiological follow-up was 60.2 and 53.0 months, respectively.
Results: The actuarial tumor cyst control rate was 86.0 ± 5.3% at 12, 24, and 60 months. The development of new cysts or progression of solid tumor parts (out-of-field progression) occurred in 18 patients (29.4%). Actuarial out-of-field control rates were 90.9 ± 4.3%, 84.0 ± 5.6%, and 54.5 ± 8.8% after 12, 24, and 60 months, respectively. Visual function improved in 12 patients (23.5%); remained unchanged in 34 patients (68.8%); and worsened in five patients (9.8%), correlating to tumor progression in each case. None of the patients showed permanent visual deterioration related to the instillation of 32P. Endocrinological deterioration occurred in 10 patients (21.6%); 9 as a result of tumour progression or after tumour resection and 1 attributed to irradiation. Within 6 months after IBT 7 patients (13.7%) experienced transient neurological deficits and 2 patients (3.9%) permanently deteriorated (hemiparesis and third nerve palsy).
Conclusions: Stereotactically applied 32P is highly efficacious for the control of cystic components of craniopharyngiomas and is associated with a low risk of permanent morbidity. Yet, this procedure does not affect the development of new cysts or the progression of solid tumor parts.
