Comparing Surgery Alone or Surgery plus Radiation Therapy in Craniopharyngioma Management

Abstract

BACKGROUND: The management approach for craniopharyngioma has not reach a consensus between neurosurgeons and radiation oncologists for the past decades. We reviewed our experience and assessed the outcome of these 2 approaches. METHOD: This is a retrospective review and children with oncological conditions were admitted to 5 public hospitals. Their data were collected prospectively by 2 full time data managers. Patients’ progress was updated annually and the data were crossed checked by the principle investigators. Survival data was analyzed by the Kaplan-Meier Analysis. RESULT: From Jan 1994 to Dec 2016 (13-yrs), 21 children (<18yrs) with craniopharyngioma was identified. The estimated incidence was 1.47/million children<15yrs/yr. M:F=10:9 and median age was 9.7yrs (range 2mons to 16.5yrs). 12/21 (57%) children were treated with surgery alone as primary approach. Even statistically insignificant, the 6yrs relapse-free-survival was 80% vs 50.3% between surgery+radiation therapy (RT) vs surgery alone. 8/13(61.5%) children in one hospital (HospA) were treated with surgery+RT as primary approach if there was residual lesion post-operatively, but other hospitals (Others) mainly adopted surgery alone as primary approach. The relapsed rate was only 1/13 (7.7%) from HospA. However, 6/8 (75%) patients in Others relapsed and 3 patients eventually died (2 disease progression; 1 sepsis). The overall incidence of hypopituitarism was lower in the HospA (72% vs 87.5%). No other radiation induced complication was noted. CONCLUSION: If with residue, surgery alone approach for craniopharyngioma is associated with a high risk of relapse. Despite being a benign tumor, patients with multiple relapses can have fatal outcome.