ESTRO 2024 - Abstract Book

S872

Clinical - CNS

ESTRO 2024

Fractionated stereotactic radiotherapy in adult craniopharyngiomas: institutional experience

Maria Hernandez Miguel, Raquel Benlloch Rodriguez, Maria Isabel Garcia Berrocal, Jesus Romero Fernandez, Marta Lopez Valcarcel, Beatriz Gil Haro, Sofia Santana Jimenez, Sara Perez Mata, Francisco Javier Martinez Paredes, Cristina de la Fuente Alonso, Irma Zapata Paz, Sofia Cordoba Largo, Joaquin Velasco Jimenez

Hospital Universitario Puerta de Hierro (Majadahonda), Radiation Oncology, Madrid, Spain

Purpose/Objective:

Craniopharyngiomas are rare intracranial tumors. Despite being histologically benign, their closeness to critical structures, such as third ventricle, circle of Willis, optic pathways, hypothalamus and pituitary stalk, and their propensity for recurrence make them potencially dangerous. The optimal treatment of adult craniopharyngioma is still a matter of debate. We aimed to evaluate treatment-related complications, long-term outcomes and quality of life (QoL) in adult patients (p) with craniopharyngioma treated with surgery and Fractionated Stereotactic Radiotherapy (FSRT) in our institution.

Material/Methods:

Between 2002 and 2019, 31p with craniopharyngioma were treated with FSRT. Sex: 18 male and 13 female. Median age: 42 years (range 15-74). Adjuvant FSRT was given after subtotal resection or progressive disease at a median dose of 50.4Gy at 1.8Gy/day. To assess treatment- related complications and QoL, “Craniofaryngioma Clinical Status Scale” and “Functional Classification Scale” were used, which were completed before and after surgery and after FSRT. Follow-up was carried out with opthtalmological, neurological and endocrinological examinations and MRI every 3-6 months.

Statistics: Student T, Kaplan-Meier and long rank test.

Results:

At diagnosis, 22p (71%) had visual dysfunction consisting in acuity deficits (10p) and visual field loss (12p). Neurological deficit was observed in 2p (6.5%). Five patients had diabetes insipidus (16.1%), of whom 4p also had panhypopituitarism. Hipothalamic dysfunction was observed in 12p (38.7%). All patients had good cognitive status. After surgery, deterioration in visual status occurred in 11p (35.5%), of whom 4p had bilateral blindness. Improvement in visual status occurred in 2p. Neurological function worsened in 5p (16.1%), 4 of whom had mild deficits and 1p moderate deficits. Pituitary function worsened in 23p (74.2%) of whom 20p (64.5%) had diabetes insipidus, and of those, 16p also developed panhypopituitarism. Hypothalamic function worsened in 15p (48.4%), of whom 9p and 1p had moderate and severe deficit respectively. Cognitive status worsened in 9p (29%), resulting in severe deficit in 1 of them. After FSRT, no patients had decreased vision nor hypothalamic functions and improvement occurred in 7p (22.6%) and 6p (19.4%), respectively. Worsening of neurological function was observed in 2p (6.5%), while 3p (9.7%) improved neurological status. Only 1p (3.2%) showed worse pituitary function. Cognitive status worsened in 2p and improved in 2p (6.5%).