Title : Should post-operative stereotactic radiosurgery be the standard of care in craniopharyngioma patients?
Abstract:
Objective: To analyse the clinical and radiological outcomes in patients receiving adjuvant gamma knife radiosurgery (GKRS) / radiotherapy (RT) for residual and recurrent craniopharyngiomas, and compare outcomes with patients who did not receive any postoperative radiotherapy.
Methods: In this retro-prospective case-control study, we enrolled all consecutive patients who received adjuvant RT or GKRS for recurrent/ residual craniopharyngiomas over 9 years (January 2011- December 2019), with a minimum radiological follow up of 12 months. Consecutive surgically treated craniopharyngioma patients over two years (January 2018- December 2019). who did not receive any postoperative radiotherapy constituted the control group . The clinical, and radiological outcomes were compared between the two groups.
Results: A total of 79 patients were enrolled for this study. 35 patients received GKT or RT, with a median age of 21 years (range 6-55 years). At a median follow up of 60.1 months (range 24 to 118 months), the tumor control rate was 91.4% (n=32). In the control group there were a total of 44 patients, with a median age of 16 years (range 3-48 years), and a median follow-up of 38.8 months; The mortality rate was 5.71% (n=2) in the group that received GKT/RT, compared to 25% (n=11) in the operative group, including a perioperative mortality of 11.4% (n=5).
Kaplan-Meier analysis, and log-rank tests showed longer progression free survival (PFS) and overall-survival (OS) rates for patients receiving post-operative GKT/RT (5-year PFS of 92.3% vs 77.4%, p=0.03, and 5-year OS of 92.0% vs 74.6%, p=0.01) . Cox proportional-hazards results showed adjuvant GKRS/RT (HR = 0.158, 95% CI = 0.033-0.757) to be an independent prognostic factor for overall survival in craniopharyngioma patients.
Conclusions: This study shows that Gamma Knife radiosurgery offers improved clinical and radiological outcomes as compared to only surgery, and should be considered in all patients with residual/ recuurent disease.
Abbreviations:
GKRS : Gamma Knife Radiosurgery
RT: Radiotherapy
PFS: Progression Free Survival
OS: Overall Survival
