ESTRO 2024 - Abstract Book

S916

Clinical - CNS

ESTRO 2024

1 All India Institute of Medical Sciences, Department of Radiation Oncology, NewDelhi, India. 2 All India Institute of Medical Sciences, Department of Pathology, NewDelhi, India. 3 All India Institute of Medical Sciences, Department of Neurosurgery, NewDelhi, India

Purpose/Objective:

The study aims to assess the patterns of care and treatment outcomes in patients who received adjuvant radiotherapy for craniopharyngioma, treated at our institute from 2007- 2022.

Material/Methods:

Patients with histology-proven craniopharyngioma were included in this retrospective analysis. Progression free survival (PFS) was defined as the time interval from the date of surgery to the date of disease progression or death. Overall survival (OS) was defined from the date of surgery to the last follow-up or death. Univariate log-rank test and multivariate Cox proportional regression analysis were done to evaluate the relationship between treatment factors and survival outcomes. Time-to-event data was evaluated using Kaplan. -Meier method.

Results:

A total of 56 patients with histology-proven craniopharyngioma were included in the retrospective study. The mean age at diagnosis was 18.9 years (IQR= 5- 48). 21.4% of patients were less than 10 years, 37.5% were between 10-20 years and 39.3% were more than 20 years of age at diagnosis. The majority (69.6%) of the patients were male. The male-to-female ratio was 7:3. The most common presenting symptoms were visual disturbances (73.2%), followed by raised intracranial tension (41.1%) and hormonal imbalance (7.2%). 64.3% had symptom duration of more than 6 months at presentation. The tumor size was less than 4cm in 60.7% of patients. Gross total excision was possible in 30.4% of patients. The excision was near total in 39.3% and subtotal in 23.2% whereas 7.1% underwent debulking surgery. 76.8% of patients received adjuvant radiotherapy, the technique being 3D-conformal in 60.7% and IMRT /VMAT in 39.3%. The median radiotherapy dose was 55Gy (range 50.4Gy- 56Gy). Post-treatment one-year response assessment showed complete response in 69.6%, partial response in 19.6%, stable disease was observed in 8.9 %, and progression in 1.7%. After surgery, 23.2% were kept on close surveillance among whom 69.2% developed recurrences. The salvage options were revision surgery in two patients and all other patients received salvage radiotherapy. Median follow-up was 11.9 years (IQR: 5.5- 14.6). The mean PFS was 14.1 years (range: 12.6- 15.7). In univariate and multivariate analysis, radiotherapy dose less than or equal to 54 Gy was associated with inferior PFS (p- value= 0.019; HR= 3.65; 95%CI=1.24- 10.78).

Conclusion:

Surgery with adjuvant radiotherapy provides good long-term OS and PFS. The anatomical proximity of the suprasellar tumor to the hypothalamic-pituitary axis and optic structures confer significant long-term sequelae. Efforts in reducing treatment-related morbidity have to be addressed with due priority.

Keywords: craniopharyngioma, surgery, radiotherapy