Pollock B E, Lunsford L D, Kondziolka D, Levine G, Flickinger J C
Department of Neurological Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):437-46. doi: 10.1016/0360-3016(95)00175-X.
The management of patients with craniopharyngiomas is often multifaceted and multidisciplinary. The purpose of this study was to examine the results of phosphorus-32 intracavitary irradiation in the treatment of patients with predominately cystic craniopharyngiomas.
Thirty patients with cystic craniopharyngiomas underwent phosphorus-32 intracavitary irradiation at our center between 1981 and 1993. The median patient age was 26 years (range, 3-70 years). Thirteen patients had intracavitary irradiation as the primary surgery for their cystic tumors, whereas 17 patients had adjuvant intracavitary irradiation after microsurgical resection, fractionated radiotherapy, or both. Patients in the adjuvant treatment group were more likely to have preoperative anterior pituitary insufficiency (p = 0.008 Fischer exact test) and diabetes insipidus (p = 0.003 Fischer exact test). The median follow-up was 37 months (mean, 46 months, range, 7-116 months).
Phosphorus-32 intracavitary irradiation resulted in cyst regression in 28 of 32 treated cysts (88%). Ten patients (33%) have had tumor progression requiring further surgical intervention. Three patients (10%) died: two of tumor progression, and one of unrelated causes. Visual acuity and fields improved or remained stable in 63% of the patients. Fifteen patients had residual anterior pituitary function before intracavitary irradiation and 10 (67%) retained their preoperative endocrine status. New-onset diabetes insipidus occurred in 3 of 17 patients (18%) who had normal posterior pituitary function preoperatively. Fourteen of 20 adult patients (70%) continued to perform at their preoperative functional level; 3 of 5 pediatric patients who were age appropriate at the time of treatment continued to develop normally. No difference was noted between primary and adjuvant treatment patients with respect to cyst control, visual deterioration, or endocrine preservation after phosphorus-32 intracavitary irradiation.
The goals of craniopharyngioma management should be tumor control with preservation of visual, endocrine, and cognitive function. Phosphorus-32 intracavitary irradiation is an important option that enhances the likelihood of achieving these goals in patients with primarily cystic craniopharyngiomas.
颅咽管瘤患者的管理通常涉及多方面且需要多学科协作。本研究的目的是探讨³²P腔内照射治疗以囊性为主的颅咽管瘤患者的疗效。
1981年至1993年间，30例囊性颅咽管瘤患者在本中心接受了³²P腔内照射。患者年龄中位数为26岁（范围3 - 70岁）。13例患者将腔内照射作为其囊性肿瘤的初次手术治疗，而17例患者在显微手术切除、分次放疗或两者联合后接受辅助性腔内照射。辅助治疗组患者术前更易出现垂体前叶功能减退（Fisher确切概率检验，p = 0.008）和尿崩症（Fisher确切概率检验，p = 0.003）。中位随访时间为37个月（平均46个月，范围7 - 116个月）。
³²P腔内照射使32个接受治疗的囊肿中的28个（88%）囊肿缩小。10例患者（33%）出现肿瘤进展，需要进一步手术干预。3例患者（10%）死亡：2例死于肿瘤进展，1例死于无关原因。63%的患者视力和视野改善或保持稳定。15例患者在腔内照射前有垂体前叶功能残留，其中10例（67%）维持了术前的内分泌状态。17例术前垂体后叶功能正常的患者中有3例（18%）出现了新发尿崩症。20例成年患者中有14例（70%）继续保持术前的功能水平；5例治疗时年龄合适的儿科患者中有3例继续正常发育。³²P腔内照射后，在囊肿控制、视力恶化或内分泌功能保留方面，初次治疗和辅助治疗的患者之间未观察到差异。
颅咽管瘤治疗的目标应是控制肿瘤并保留视觉、内分泌和认知功能。³²P腔内照射是一种重要的选择，可提高主要为囊性颅咽管瘤患者实现这些目标的可能性。
