ESTRO meets Asia 2024 - Abstract Book

S104

Interdisciplinary – CNS

ESTRO meets Asia 2024

objective was progression-free survival (PFS), and the secondary objectives were overall survival (OS), local control, and toxicity.

Results:

In our study of 98 patients with craniopharyngioma, the first progression-free survival at 5 and 8 years was 39.26% and 37.86%, respectively. Notably, surgery combined with early radiotherapy significantly improved outcomes to 87.5% at both time points compared to the no radiotherapy group (5 years 1st PFS: 87.5% vs. 34.52%, 8 years 1st PFS: 87.50% vs. 32.88%, HR 0.21, p-value = 0.033), while intracystic chemotherapy treatment showed worsen outcome compared to non-intracystic chemotherapy treatment (HR 54.28, p < 0.001). Disease progression occurred in 63.27%, with varied salvage treatments. Among those receiving the first salvage treatment, the second progression-free survival at 5 and 8 years was 45.27% and 36.74%, respectively, with a significant impact of radiotherapy on greater second progression-free survival compared with no radiotherapy (5y 2 nd PFS: 78.35% vs 32.38%, 8y 2 nd PFS: 78.35% vs 18.50%, HR=0.15, p=0.002). Overall survival at 5 years and 8 years was 100% and 94.17%, respectively, showing no statistically significant benefit between radiotherapy treatment and the no radiotherapy group. Local control at 5 and 8 years was approximately 40%, with better outcomes seen with surgery combined with early radiotherapy (5y LC: 87.5% vs 36.14%, 8y LC: 87.5% vs 34.42%, HR=0.22, p=0.038). However, injection chemotherapy into cystic part of tumor significantly worsened local control outcome (HR=51.97, p<0.001). Radiation failure-free survival at 8 years for radiotherapy was 81.41%. Late toxicities after treatment included endocrine disorders, visual abnormalities, intracerebral vascular issues, secondary tumors, and psychological problems showing 61-86%, 87%, 6%, 2%, and 6%, respectively. Furthermore, there was an increase in BMI by 7 kg/m2. The median pre-treatment BMI was 24.28 kg/m2, and the median post-treatment BMI was 26.94 kg/m2. Our study of craniopharyngioma patients at Ramathibodi Hospital revealed a lower primary progression-free survival (PFS) at 5 and 8 years compared to other studies, especially in cases of gross total tumor resection and those receiving radiotherapy. Radiotherapy, whether as primary or salvage treatment, significantly improved 5 year and 8-year PFS and local control. Conversely, intracystic chemotherapy negatively impacted both first progression-free survival rates, as well as local control. However, overall survival showed no significant difference. Late toxicities, including growth hormone disorder, hypothyroidism, delayed puberty, visual disorders, BMI, intracerebral vascular deficit, secondary brain tumors, and psychological problems at Ramathibodi Hospital, were comparable to other studies, but the comparison was limited by incomplete data. A complete medical record is recommended for a more accurate analysis. Conclusion:

Keywords: craniopharyngioma, survival, toxicity

References:

1.

Müller

HL,

Merchant

TE,

Warmuth-Metz

M,

Martinez-Barbera

JP,

Puget

S.

Craniopharyngioma. Nat Rev Dis Primers. 2019;5(1):75.

2. Prieto R, Rosdolsky M, Hofecker V, Barrios L, Pascual JM. Craniopharyngioma treatment: an updated summary of important clinicopathological concepts. Expert Rev Endocrinol Metab. 2020;15(4):261-82. 3. Stripp DC, Maity A, Janss AJ, Belasco JB, Tochner ZA, Goldwein JW, et al. Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. Int J Radiat Oncol Biol Phys. 2004;58(3):714-20.