gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Outcomes of Pediatric Craniopharyngioma Treated with Proton Radiation Therapy

Meeting Abstract

  • A. Chang - Midwest Proton Radiotherapy Institute, Bloomington, USA
  • M. Fitzek - Midwest Proton Radiotherapy Institute, Bloomington, USA
  • L. Kruter - Indiana University, Indianapolis, USA
  • A. Thornton - Midwest Proton Radiotherapy Institute, Bloomington, USA

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog035

DOI: 10.3205/09ptcog035, URN: urn:nbn:de:0183-09ptcog0353

Published: September 24, 2009

© 2009 Chang et al.
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Outline

Text

Purpose/Objective(s): Craniopharyngiomas constitute approximately 8% of childhood brain tumors. Although they are benign without potential for spread, they can lead to significant morbidity from mass effect. This is especially the case due to the critical location these tumors occupy adjacent to the optic chiasm, pituitary, hypothalamus, and brainstem. Gross total resection of craniopharyngiomas is curative, however, this is not often possible due to the proximity of the critical structures. Conventional external beam radiation therapy improves the chances of local control. We undertook an evaluation of outcomes of patients with craniopharyngioma treated at the Midwest Proton Radiotherapy Institute (MPRI) with proton radiation therapy (PRT).

Materials/methods: A retrospective chart review was conducted of each patient with the diagnosis of craniopharyngioma. From 2004 through 2008, 14 patients with craniopharyngioma have been treated at MPRI. They ranged in age from 5 to 19 years of age (median 13.5 years) at time of treatment. Each patient had pathology proven craniopharyngioma after biopsy or surgical resection. Radiation was delivered in a daily fractionated rate of 1.8 Cobalt Gray Equivalent (CGE) per fraction, 5 fractions per week to a total of median 54.0 CGE (range 50.4–57.6 CGE). One patient was started urgently with conventional photon radiation due to progressive visual loss from mass effect before switching to PRT. A second patient was retreated for recurrence with proton radiation therapy after having received 55.4 Gray (Gy) 8 years previously with conventional fractionated photon radiotherapy. Post-radiation therapy imaging and records were reviewed for outcome.

Results: At a mean followup of 22 months (range 11 - 45 months), local control is 100%. There have been no deaths. There was no difference in outcomes regardless of extent of surgery nor number of surgical resection. Vision has stabilized or improved in all patients. None had further decline of visual symptoms after radiation therapy. All 11 patients with endocrine results available had some component of pituitary insufficiency. All 11 had low levels of growth hormone (GH), 81% of which were present prior to PRT. GH was followed by thyroid hormone (TH) deficiency in 90% of patients, and adrenal insufficiency in 89%. TH deficiency and adrenal insufficiency were present prior to PRT in all cases.

Conclusions: Proton radiotherapy after minimal surgical resection results in excellent control of craniopharyngioma. The treatment is well tolerated with minimal complications. Although pituitary insufficiencies were common, the vast majority were present prior to proton radiotherapy. Further follow-up is needed to determine neuro-cognitive outcomes.