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Clinical outcomes following proton therapy for adult craniopharyngioma: a single-institution cohort study

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A Correction to this article was published on 22 March 2021

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Abstract

Background

Craniopharyngioma is a benign tumor that commonly develops within the suprasellar region. The tumor and treatment can have debilitating consequences for pediatric and adult patients, including vision loss and pituitary/hypothalamic dysfunction. Most craniopharyngioma series focus on treatment of the pediatric population. We evaluated the outcomes of all adult craniopharyngioma patients treated at our institution using proton therapy to report outcomes for disease control, treatment-related toxicity, and tumor response.

Methods

We analyzed 14 adult patients (≥ 22 years old). All patients had gross disease at the time of radiotherapy. Five were treated for de novo disease and 9 for recurrent disease. Patients received double-scattered conformal proton therapy to a mean dose of 54 GyRBE in 1.8 GyRBE/fraction (range 52.2–54 GyRBE). Weekly magnetic resonance imaging (MRI) helped to evaluate tumor changes during radiotherapy.

Results

With median clinical and radiographic follow-up of 29 and 26 months, respectively, the 3-year local control and overall survival rates were both 100%. There were no grade 3 or greater acute or late radiotherapy-related side effects. There was no radiotherapy-related vision loss or optic neuropathy. No patients required intervention or treatment replanning due to tumor changes during radiotherapy. Two patients experienced transient cyst expansion at their first post-radiotherapy MRI. Both patients were followed closely clinically and radiographically and had subsequent dramatic tumor/cyst regression, requiring no interventions.

Conclusions

Our data support the safety and efficacy of proton therapy in the treatment of adult craniopharyngioma as part of primary or salvage treatment. We recommend early consideration of radiotherapy.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA

    Michael S. Rutenberg, Adam L. Holtzman, Daniel J. Indelicato, Soon Huh & William M. Mendenhall

  2. Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA

    Ronny L. Rotondo

  3. Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA

    Dinesh Rao

  4. University of Florida Health Proton Therapy Institute, 2015 N Jefferson St, Jacksonville, FL, 32206, USA

    Michael S. Rutenberg, Adam L. Holtzman, Daniel J. Indelicato, Soon Huh, Christopher G. Morris & William M. Mendenhall

Authors
  1. Michael S. Rutenberg
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  2. Ronny L. Rotondo
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  3. Dinesh Rao
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  4. Adam L. Holtzman
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  5. Daniel J. Indelicato
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  6. Soon Huh
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  7. Christopher G. Morris
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  8. William M. Mendenhall
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Contributions

Study design, MSR; Data Collection, MSR; Statistical Analysis, CGM; Data Interpretation, MSR, RLR, DR, ALH, DJI, SH, WMM; Drafting Manuscript, MSR; Final Approval of Manuscript, MSR, RLR, DR, ALH, DJI, SH, WMM.

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Correspondence to Michael S. Rutenberg.

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The original version of this article has been revised: The Abstract has been corrected.

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Supplementary file1 (DOCX 16 kb)

11060_2020_3432_MOESM2_ESM.tif

Supplementary file2 (TIF 475 kb) Supplementary Fig. 1. Intensity-modulated radiation therapy (IMRT) and 3-dimensional (3D) conformal proton radiotherapy treatment plan comparison for adult craniopharyngioma. A representative case of treatment planning comparison between 7-field IMRT (left images) and 3D conformal passively scattered proton radiotherapy (right images). The planning target volume (PTV) delineated by the green line and PTV coverage is the same for both plans. Shaded colorwash shows doses ranging from 10 GyRBE to the maximum dose for each plan. Low dose (10 GyRBE in blue) and intermediate dose (30 GyRBE in teal) spread far beyond the target volume and extend further into normal brain and eyes with the IMRT plan compared to the proton plan. The prescription dose and high dose radiation (yellow and red) are similar between both treatment modalities

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Rutenberg, M.S., Rotondo, R.L., Rao, D. et al. Clinical outcomes following proton therapy for adult craniopharyngioma: a single-institution cohort study. J Neurooncol 147, 387–395 (2020). https://doi.org/10.1007/s11060-020-03432-9

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  • DOI: https://doi.org/10.1007/s11060-020-03432-9

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