Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
J Neurooncol. 2012 Sep;109(2):349-55. doi: 10.1007/s11060-012-0900-x. Epub 2012 Jun 13.
Clinical experience suggests that craniopharyngiomas may temporarily increase in size after radiation therapy (RT). The study goal is to determine the incidence and natural history of this response in a cohort of patients managed at Children's Healthcare of Atlanta (CHOA) or Emory Healthcare (EHC). Between 08/1998 and 06/2009, 41 children and young adults were diagnosed with craniopharyngioma at CHOA and/or EHC. Of these, 21 received external-beam radiation and were included in our analysis. Serial magnetic resonance imaging (MRI) studies were evaluated volumetrically to assess response to RT. Median age at diagnosis was 8.2 years (range 3.2-23.5 years). Median radiation dose was 54.0 Gy using standard fractionation (1.8-2.0 Gy/day). With median follow-up of 41.3 months (range 7.2-121.8 months), actuarial local control and overall survival rates at 5 years were 78.7 % and 100 %, respectively. Of subjects, 52.4 % of subjects (11 of 21) were noted on serial MRI evaluation to have tumor enlargement (mostly cystic component) after radiation before eventual shrinkage without further intervention. For tumors that expanded, the median volume increase was 33.9 % (range 15.6-224.4 %). Median time to maximal tumor/cyst expansion was 1.5 months (range 1.0-5.0 months). Finally, nearly all patients (20 of 21) showed a measurable objective response to therapy by MRI regardless of ultimate disease control. Median time to maximal response post-radiation, as defined by MRI, was 9.5 months (range 3.5-39.9 months). In summary, RT is effective for managing craniopharyngioma. However, despite good ultimate responses, approximately 50 % of the patients show tumor/cyst expansion on MRI over the first few months post-radiation. Caution should be taken not to subject these patients to "salvage surgery" or cyst aspiration during this early time unless there are other overriding surgical indications. Understanding the natural history of this phenomenon could potentially help guide the management of these craniopharyngioma patients.
临床经验表明，颅咽管瘤在接受放射治疗（RT）后可能会暂时增大。本研究旨在确定在亚特兰大儿童保健中心（CHOA）或埃默里保健中心（EHC）接受治疗的患者队列中这种反应的发生率和自然史。在 1998 年 8 月至 2009 年 6 月期间，CHOA 和/或 EHC 诊断出 41 名儿童和年轻成人颅咽管瘤患者。其中，21 人接受了外照射放疗，纳入了我们的分析。对连续的磁共振成像（MRI）研究进行了体积评估，以评估对 RT 的反应。中位诊断年龄为 8.2 岁（范围 3.2-23.5 岁）。中位放射剂量为 54.0 Gy，采用标准分割（1.8-2.0 Gy/天）。中位随访时间为 41.3 个月（范围 7.2-121.8 个月），5 年局部控制和总生存率分别为 78.7%和 100%。在连续 MRI 评估中，有 52.4%（21 例中有 11 例）的患者发现肿瘤（主要是囊性成分）在放疗后增大，最终在没有进一步干预的情况下缩小。对于肿瘤增大的患者，中位体积增加 33.9%（范围 15.6-224.4%）。肿瘤/囊肿最大扩张的中位时间为 1.5 个月（范围 1.0-5.0 个月）。最后，无论最终疾病控制如何，几乎所有患者（21 例中有 20 例）在 MRI 上都显示出对治疗有可测量的客观反应。根据 MRI 定义，放疗后最大反应的中位时间为 9.5 个月（范围 3.5-39.9 个月）。总之，RT 是治疗颅咽管瘤的有效方法。然而，尽管最终反应良好，但大约 50%的患者在放疗后最初几个月内 MRI 上显示肿瘤/囊肿增大。除非有其他主要手术指征，否则在这段时间内不应对这些患者进行“挽救性手术”或囊肿抽吸。了解这种现象的自然史可能有助于指导这些颅咽管瘤患者的治疗。
