Radiotherapy for craniopharyngioma
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Radiotherapy for craniopharyngioma Ajay Aggarwal • Naomi Fersht • Michael Brada
Ó Springer Science+Business Media, LLC 2012
Abstract Radiotherapy remains the mainstay of multidisciplinary management of patients with incompletely resected and recurrent craniopharyngioma. Advances in imaging and radiotherapy technology offer new alternatives with the principal aim of improving the accuracy of treatment and reducing the volume of normal brain receiving significant radiation doses. We review the available technologies, their technical advantages and disadvantages and the published clinical results. Fractionated high precision conformal radiotherapy with image guidance remains the gold standard; the results of single fraction treatment are disappointing and hypofractionation should be used with caution as long term results are not available. There is insufficient data on the use of protons to assess the comparative efficacy and toxicity. The precision of treatment delivery needs to be coupled with experienced infrastructure and more intensive quality assurance to ensure best treatment outcome and this should be carried out within multidisciplinary teams experienced in the management of craniopharyngioma. The advantages of the combined skills and expertise of the team members may outweigh the largely undefined clinical gain from novel radiotherapy technologies. Keywords Craniopharyngioma Radiotherapy Radiosurgery Stereotactic radiotherapy IMRT
A. Aggarwal N. Fersht M. Brada University College London Hospitals, London, UK M. Brada (&) Leaders in Oncology Care, 95 Harley Street, London W1G 6AF, UK e-mail: [email protected]
Introduction Radiotherapy is an integral component of management of children and adults with craniopharyngioma. The principal aim has been and remains the achievement of long term disease control in patients with residual or recurrent tumours where complete surgical removal is considered inappropriate due to unacceptable morbidity. We review the current evidence advocating its use particularly in the light of advances in surgery and technical advances in radiotherapy delivery.
Rationale for radiotherapy The rationale for radiotherapy has been the recognition of significant morbidity [1–5] and mortality following radical compared with conservative surgery [1, 2, 6], combined with the excellent local control achieved with the combination of partial surgical excision and radiotherapy compared to attempts at complete excision alone [7–11]. In addition, the use of radiotherapy following incomplete removal of craniopharyngioma largely avoids the need for repeat surgery which has been associated with further morbidity and mortality [2, 3]. The 10 year tumour control rates reported in single arm, often retrospective, studies (75–90 %) [7–12] were superior to the results following incomplete excision alone (30–50 %) [6, 7, 13, 14] and have led to radiotherapy being considered the standard of care for patients with residual and recurrent disease. While the results were based on conventional fracti
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