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Is Postoperative Radiotherapy Needed in the Management of Adult Craniopharyngiomas?

Published online by Cambridge University Press:  18 May 2022

Julia Khriguian
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
Marwan Tolba
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
Farzin Khosrow-Khavar
Affiliation:
Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
Sarah Kordlouie
Affiliation:
Faculty of Medicine, McGill University, Montreal, Quebec, Canada
Marie-Christine Guiot
Affiliation:
Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
Bassam Abdulkarim
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
George Shenouda
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
Denis Sirhan
Affiliation:
Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
Luis Souhami
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
Valerie Panet-Raymond*
Affiliation:
Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
*
Corresponding author: Valérie Panet-Raymond, MD, Cedars Cancer Centre, Radiation Oncology, McGill University Health Centre, 1001 Décarie Boulevard, Montreal, QC, Canada, H4A 3J1. Email: valerie.panet-raymond@mcgill.ca

Abstract:

Background:

The optimal treatment of adult craniopharyngioma (CP) remains controversial. Although benign, these tumors tend to recur locally. The choice between gross total resection (GTR) versus subtotal resection (STR) with adjuvant or delayed radiotherapy (RT) is debated. The objective of this study is to review our experience with adult CPs over a 20-year period and identify an optimal management strategy.

Methods:

From 1999 to 2020, we reviewed all patients diagnosed with CP at our institution. We collected data regarding tumor characteristics, treatments, and toxicity. Disease progression was defined as growth on imaging. Descriptive statistics were used to assess patient characteristics. The Kaplan Meier method was used to assess progression-free survival (PFS) and corresponding 95% confidence intervals (CI) from the time since treatment initiation.

Results:

Twenty-four patients with a median age of 50 were included in this study. The median follow-up was 85 months. Seven patients had initial GTR, 10 STR, and 7 STR + RT. The overall 5-year PFS was 56% (95% CI: 38–83%): 100% in the STR + RT group, 69% in the GTR group, and 18% in the STR group (p = 0.01). Of the 17 patients initially treated with surgery alone, 3 with GTR and 6 with STR required salvage RT at a median of 46 months, with no further progression after salvage RT.

Conclusions:

Our study underscores the importance of RT for local control and suggests that STR + RT should be considered a viable option in the management of these tumors as it may be associated with improved PFS compared to surgery alone.

Résumé :

RÉSUMÉ :

La radiothérapie postopératoire : nécessaire dans la prise en charge des craniopharyngiomes chez l’adulte?

Contexte :

Le traitement optimal des craniopharyngiomes (CP) chez l’adulte suscite la controverse. Bien que ces tumeurs soient bénignes, elles comportent des risques de récidive locale. Il sera donc question du choix entre l’exérèse totale brute (ETB) et la résection partielle (RP) suivie de radiothérapie (RT) d’appoint ou de radiothérapie différée. Pour ce faire, l’étude visait à passer en revue l’expérience du traitement des CP chez des adultes, sur une période de plus de 20 ans, et à dégager la meilleure stratégie de prise en charge qui soit.

Méthode :

Ont été examinés les dossiers de tous les patients chez qui avait été posé un diagnostic de CP, de 1999 à 2020, dans l’établissement des auteurs. Il y a eu collecte de données sur les caractéristiques des tumeurs, les traitements et leur toxicité. L’évolution de la maladie était définie par le développement d’une masse à l’imagerie. L’évaluation des caractéristiques des patients repose sur des statistiques descriptives. La méthode d’estimation de Kaplan-Meyer a servi à l’évaluation de la survie sans évolution (SSE) et des intervalles de confiance (IC) à 95 % correspondants, établis depuis le début du traitement.

Résultats :

L’étude comptait 24 dossiers de patients d’un âge médian de 50 ans, et la durée médiane du suivi était de 85 mois. Au départ, 7 patients ont subi une ETB; 10, une RP; et 7, une RP+RT. La SSE générale au bout de 5 ans était de 56 % (IC à 95 % : 38–83 %) et elle se répartissait ainsi : 100 % dans le groupe de RP + RT; 69 % dans le groupe d’ETB et 18 % dans le groupe de RP (p = 0,01). Sur les 17 patients traités initialement par la chirurgie seule, 9 d’entre eux, soit 3 par l’ETB et 6 par la RP, ont dû subir une RT de rattrapage au bout d’une période médiane de 46 mois, sans évolution ultérieure de la tumeur.

Conclusion :

Les résultats de l’étude font ressortir l’importance de la RT dans la lutte contre la réapparition locale du CP, et donnent à penser que la RP + RT devrait être considérée comme une intervention offrant une perspective favorable dans la prise en charge de ce type de tumeurs, le traitement pouvant être associé à une amélioration de la SSE, comparativement à la chirurgie seule.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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