Craniopharyngioma: treatment in the CT and MR imaging era.

Abstract

PURPOSE: To determine optimal treatment in patients with craniopharyngiomas. MATERIALS AND METHODS: In 1977-1990, 49 patients (age range, 3-67 years; median age, 35 years; 25 female, 24 male) with craniopharyngiomas were examined. Follow-up was 5-17 years (median, 8 years). Fifteen patients were aged younger than 18 years. RESULTS: All patients underwent surgical resection. Complete resection was achieved in 19. Seven patients underwent additional surgery for recurrent disease. Rate of mortality due to surgical complications was 10% (n = 5). Eight patients had marked perioperative or long-term morbidity. Twenty-five patients judged to have undergone subtotal resection underwent postoperative radiation therapy (RT). RT doses were 4,600-6,287 cGy administered in fractions of 180-200-cGy/d. Actuarial 5-year progression-free survival in patients who underwent complete resection was 63% (12 of 19 patients) versus 96% (24 of 25 patients) in patients who underwent subtotal resection followed by RT (P = .04). No RT dose response was observed. Patient functional status has not been substantially affected by adjuvant RT. CONCLUSION: RT achieves excellent tumor control after subtotal resection of craniopharyngiomas.