Department of Radiation Oncology, University of California, San Francisco (UCSF), San Francisco, CA 94143-1708, USA.
J Neurooncol. 2012 May;108(1):133-9. doi: 10.1007/s11060-012-0806-7. Epub 2012 Feb 15.
The purpose of this study is to evaluate the roles of resection extent and adjuvant radiation in the treatment of craniopharyngiomas. We reviewed the records of 122 patients ages 11-52 years who received primary treatment for craniopharyngioma between 1980 and 2009 at the University of California, San Francisco (UCSF). Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were development of panhypopituitarism, diabetes insipidus (DI), and visual field defects. Of 122 patients, 30 (24%) were treated with gross total resection (GTR) without radiation therapy (RT), 3 (3%) with GTR + RT, 41 (33.6%) with subtotal resection (STR) without RT, and 48 (39.3%) with STR + RT. Median age at diagnosis was 30 years, with 46 patients 18 years or younger. Median follow-up for all patients was 56.4 months (interquartile range 18.9-144.2 months) and 47 months (interquartile range 12.3-121.8 months) for the 60 patients without progression. Fifty six patients progressed, 10 have died, 6 without progression. Median PFS was 61.1 months for all patients. PFS rate at 2 years was 61.5% (95% CI: 52.1-70.9). OS rate at 10 years was 91.1% (95% CI 84.3-97.9). There was no significant difference in PFS and OS between patients treated with GTR vs. STR + XRT (PFS; p = 0.544, OS; p = 0.735), but STR alone resulted in significantly shortened PFS compared to STR + RT or GTR (p < 0.001 for both). STR was associated with significantly shortened OS compared to STR + RT (p = 0.050) and trended to shorter OS compared to GTR (p = 0.066). GTR was associated with significantly greater risk of developing DI (56.3 vs. 13.3% with STR + XRT, p < 0.001) and panhypopituitarism (54.8 vs. 26.7% with STR + XRT, p = 0.014). In conclusion, for patients with craniopharyngioma, STR + RT may provide superior clinical outcome, achieving better disease control than STR and limiting side effects associated with aggressive surgical resection.
本研究旨在评估颅咽管瘤切除术范围和辅助放疗的作用。我们回顾了 1980 年至 2009 年期间在加利福尼亚大学旧金山分校（UCSF）接受颅咽管瘤初次治疗的 122 名年龄在 11-52 岁的患者的记录。主要终点是无进展生存期（PFS）和总生存期（OS）。次要终点是全垂体功能减退、尿崩症（DI）和视野缺损的发展。122 名患者中，30 名（24%）接受了无放疗的大体全切除（GTR）治疗，3 名（3%）接受了 GTR+RT 治疗，41 名（33.6%）接受了无放疗的次全切除（STR）治疗，48 名（39.3%）接受了 STR+RT 治疗。诊断时的中位年龄为 30 岁，46 名患者年龄在 18 岁以下。所有患者的中位随访时间为 56.4 个月（四分位距 18.9-144.2 个月），60 名无进展患者的中位随访时间为 47 个月（四分位距 12.3-121.8 个月）。56 名患者进展，10 名死亡，6 名无进展。所有患者的中位 PFS 为 61.1 个月。2 年时 PFS 率为 61.5%（95%CI：52.1-70.9）。10 年 OS 率为 91.1%（95%CI 84.3-97.9）。GTR 与 STR+XRT 治疗的患者 PFS（p=0.544）和 OS（p=0.735）无显著差异，但与 STR+RT 或 GTR 相比，STR 单独治疗的 PFS 明显缩短（均 p<0.001）。STR 与 STR+RT 相比，OS 明显缩短（p=0.050），与 GTR 相比，OS 有缩短趋势（p=0.066）。GTR 与更严重的 DI（56.3%比 STR+XRT 组 13.3%，p<0.001）和全垂体功能减退（54.8%比 STR+XRT 组 26.7%，p=0.014）风险增加相关。总之，对于颅咽管瘤患者，STR+RT 可能提供更好的临床结果，比 STR 更好地控制疾病，同时限制与积极手术切除相关的副作用。
