Hypothalamic obesity is common among patients with craniopharyngioma. This study examined whether precise stereotactic radiosurgery reduces the risk of hypothalamic obesity in cases of craniopharyngioma with expected long-term survival.

This cohort study included 40 patients who had undergone Gamma Knife radiosurgery (GKRS; n = 22) or fractionated radiotherapy (FRT; n = 18) for residual or recurrent craniopharyngioma. Neurological presentations, tumor volume changes, and BMI values were meticulously reviewed. The median clinical follow-up durations were 9.7 years in the GKRS group and 10.8 years in the FRT group.

The median ages at the time of GKRS and FRT were 9.0 years and 10.0 years, respectively. The median margin dose of GKRS was 12.0 Gy (range 10.0–16.0 Gy), whereas the median dose of FRT was 50.40 Gy (range 44.1–56.3 Gy). Prior to GKRS or FRT, the median BMI values were 20.5 kg/m² in the GKRS cohort and 20.0 kg/m² in the FRT cohort. The median BMIs after radiation therapy at final follow-up were 21.0 kg/m² and 24.0 kg/m² for the GKRS and FRT cohorts, respectively. In the FRT cohort, BMI curves rapidly increased beyond the 85th percentile of the upper limit of the general population. BMI curves in the GKRS cohort increased more gradually, and many of the patients merged into the normal growth curve after adolescence. However, the observed difference was not statistically significant (p = 0.409).

The study compared the two adjuvant radiation modalities most commonly used for recurrent and residual craniopharyngioma. The authors’ results revealed that precise radiosurgery dose planning can mediate the subsequent increase in BMI. There is every indication that meticulous GKRS treatment is an effective approach to treating craniopharyngioma while also reducing the risk of hypothalamic obesity.

下丘脑肥胖在颅咽管瘤患者中很常见。这项研究探讨了精确立体定向放射外科手术是否可以降低预期长期生存的颅咽管瘤病例下丘脑肥胖的风险。

该队列研究包括 40 名因残留或复发性颅咽管瘤接受过伽玛刀放射外科治疗 (GKRS；n = 22) 或分段放射治疗 (FRT；n = 18) 的患者。神经学表现、肿瘤体积变化和体重指数均经过仔细审查。 GKRS 组的中位临床随访时间为 9.7 年，FRT 组的中位临床随访时间为 10.8 年。

GKRS 和 FRT 时的中位年龄分别为 9.0 岁和 10.0 岁。 GKRS 的中位边缘剂量为 12.0 Gy（范围 10.0-16.0 Gy），而 FRT 的中位剂量为 50.40 Gy（范围 44.1-56.3 Gy）。在 GKRS 或 FRT 之前，GKRS 队列中的中位 BMI 值为 20.5 kg/m ² ，FRT 队列中的中位 BMI 值为 20.0 kg/m ² 。 GKRS 组和 FRT 组在最终随访时放射治疗后的中位 BMI 分别为 21.0 kg/m ²和 24.0 kg/m ² 。在 FRT 队列中，BMI 曲线迅速增加，超过了普通人群上限的第 85 个百分位。 GKRS队列中的BMI曲线增长更为缓慢，许多患者在青春期后融入了正常的生长曲线。然而，观察到的差异并不具有统计学意义（p = 0.409）。

该研究比较了最常用于复发性和残留性颅咽管瘤的两种辅助放射方式。作者的结果表明，精确的放射外科剂量计划可以调节随后的体重指数增加。种种迹象表明，细致的 GKRS 治疗是治疗颅咽管瘤的有效方法，同时还能降低下丘脑肥胖的风险。