Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA.
University of Florida Health Proton Therapy Institute, 2015 N Jefferson St, Jacksonville, FL, 32206, USA.
J Neurooncol. 2020 Apr;147(2):387-395. doi: 10.1007/s11060-020-03432-9. Epub 2020 Feb 21.
Craniopharyngioma is a benign tumor that commonly develops within the suprasellar region. The tumor and treatment can have debilitating consequences for pediatric and adult patients, including vision loss and pituitary/hypothalamic dysfunction. Most craniopharyngioma series focus on treatment of the pediatric population. We evaluated the outcomes of all adult craniopharyngioma patients treated at our institution using proton therapy to report outcomes for disease control, treatment-related toxicity, and tumor response.
We analyzed 14 adult patients (≥ 22 years old). All patients had gross disease at the time of radiotherapy. Five were treated for de novo disease and 9 for recurrent disease. Patients received double-scattered conformal proton therapy to a mean dose of 54 GyRBE in 1.8 GyRBE/fraction (range 52.2-54 GyRBE). Weekly magnetic resonance imaging (MRI) helped to evaluate tumor changes during radiotherapy.
With median clinical and radiographic follow-up of 29 and 26 months, respectively, the 3-year local control and overall survival rates were both 100%. There were no grade 3 or greater acute or late radiotherapy-related side effects. There was no radiotherapy-related vision loss or optic neuropathy. No patients required intervention or treatment replanning due to tumor changes during radiotherapy. Two patients experienced transient cyst expansion at their first post-radiotherapy MRI. Both patients were followed closely clinically and radiographically and had subsequent dramatic tumor/cyst regression, requiring no interventions.
Our data support the safety and efficacy of proton therapy in the treatment of adult craniopharyngioma as part of primary or salvage treatment. We recommend early consideration of radiotherapy. This trial was registered at www.clinicaltrials.gov as #NCT03224767.
颅咽管瘤是一种常见于鞍上区的良性肿瘤。肿瘤及其治疗可能对儿科和成人患者造成严重后果，包括视力丧失和垂体/下丘脑功能障碍。大多数颅咽管瘤系列研究都集中在儿科人群的治疗上。我们评估了我院采用质子治疗的所有成年颅咽管瘤患者的结局，以报告疾病控制、治疗相关毒性和肿瘤反应的结果。
我们分析了 14 例成年患者（≥22 岁）。所有患者在放疗时均有肉眼可见的疾病。其中 5 例为初发疾病，9 例为复发性疾病。患者接受双散射适形质子治疗，平均剂量为 54 GyRBE（范围为 52.2-54 GyRBE），1.8 GyRBE/分次。每周行磁共振成像（MRI）有助于评估放疗期间肿瘤的变化。
中位临床和影像学随访时间分别为 29 和 26 个月，3 年局部控制率和总生存率均为 100%。无 3 级或更高级别的急性或迟发性放疗相关不良反应。无放疗相关视力丧失或视神经病变。没有患者因放疗期间肿瘤变化而需要干预或治疗计划修改。2 例患者在首次放疗后 MRI 检查时出现短暂的囊肿扩张。这 2 例患者均进行了密切的临床和影像学随访，随后肿瘤/囊肿显著消退，无需干预。
我们的数据支持质子治疗作为原发性或挽救性治疗的一部分治疗成人颅咽管瘤的安全性和有效性。我们建议尽早考虑放疗。本试验在 www.clinicaltrials.gov 注册，编号为 #NCT03224767。
