Page 40 - ARNM-2-2

Advances in Radiotherapy
& Nuclear Medicine Hypofractionated radiotherapy in craniopharyngioma

3. Results (CK), and 55 Gy (HT) in 5, 5, 15, 15, and 30 fractions,
respectively. Only one adult patient (12.5%) had received
Two patients (25%) received RT under general anesthesia. tetraiodothyronine or thyroxine (T4) replacement therapy
The median time between surgery and RT was 8.5 months before RT, and she had a complete response after H-IMRT
(2.6 – 11 months). The largest mean diameter of the tumors and did not need any additional hormone therapy except
was 30.3 mm (18 – 45 mm). for the same dose of T4.
Patients included in the study were aged 4 – 26 (median: Before RT, 6 patients (75%) were using glucocorticoids
14 years). Tumor volumes ranged from 4.8 to 31.2 cc and thyroid hormone replacement therapy, 4 patients
(median: 12.2 cc). The patient, tumor, and treatment (50%) were using desmopressin, and 1 patient (12.5%)
details are summarized in Table 1.
was using growth hormone replacement therapy. After
Seven patients had undergone surgery before EBRT RT, the use of hormone replacement therapy for pituitary
(87.5%), 1 patient (12.5%) had a suprasellar tumor, insufficiency increased to some extent in 1 patient (12.5%)
and an overweight 13-year-old boy was not suitable for who had previously used triiodothyronine (T3), steroid, and
surgery. After RT, only one patient underwent surgery for desmopressin replacement therapy; it decreased in 2 (25%)
transsphenoidal cyst aspiration. All patients were followed patients and remained the same in 4 (50%) patients. It was
up after treatment with physical examination, hormonal not possible to determine whether the dose of these drugs
status, and MRI imaging at 3 –6 monthly intervals for increased after RT in one overweight patient who was already
the first 2 years and 6 –12 monthly intervals thereafter. using desmopressin, T3, steroid, and insulin before RT. This
The median follow-up was 6.5 years (2 – 9.1 years) and patient who was a 14-year-old boy, inoperable before RT due
all patients were free of progression during follow-up. to being overweight, remained with stable residual disease
All but one patient were alive (87.5%). This patient had and continued to gain weight (168 kg) after RT.
two subtotal excisions before RT and received 40 Gy in
15 fractions with CK and died under the speculation of Finally, the 1-year OS and PFS rates were 100% and
cerebral thromboembolism without tumor 21 months 100%, respectively. The 3-year OS and PFS rates were
after RT. Of the two patients (25%) alive with a complete 85.7% and 85.7%, respectively. The OS and PFS at 5 years
response, an adult patient received 50 Gy in 25 fractions were likewise 85.7% and 85.7%, respectively.
with H-IMRT, and the other received SRT through CK Figure 1 shows the MRI images taken before and after
with 20 Gy in five fractions (mean total dose: 22 Gy). In five the treatments for a 17-year-old patient. After RT, the
patients (62.5%) alive with stable residual disease, median patient experienced significant clinical improvement and
RT doses were 22 Gy (CK), 25 Gy (CK), 40 Gy (CK), 42 Gy was followed up with stable residual disease.

Table 1. Tumor, treatment, and follow‑up data
Treatment Gender Tumor Tumor location Fraction Mean Prescribed Treatment Hormone Follow‑up Follow‑up
age volume number dose dose (Gy) device using situation (year)
(cc) (Gy) at IDL
4 F 21.4 Sellar and suprasellar 5 22 18 at 71% CK ® Yes (same) Alive with 6.0
stable residue
4 M 14.6 Sellar and suprasellar 15 40 36 at 77% CK ® Yes (same) Alive with 6.0
stable residue
26 F 9.3 Suprasellar 25 50 50 at 95% HT ® No Alive without 9.1
disease
14 F 4.8 Suprasellar 30 55 54 at 95% HT ® Yes (increased) Alive with 7.9
stable residue
15 M 31.2 Suprasellar 5 22 20 at 80% CK ® Yes (decreased) Alive without 7.1
disease
8 F 11.9 Sellar and suprasellar 15 42 40 at 80% CK ® Yes (same) Dead without 1.8
disease
14 M 12.6 Suprasellar 5 25 22.5 at 77% CK ® Yes (not clear) Alive with 5.0
stable residue
17 M 10.4 Sellar 15 42 36.5 at 79% CK ® Yes (same) Alive with 2.0
stable residue
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Abbreviations: CK : CyberKnife ; HT : Tomotherapy ; IDL: Isodose line; M: Male; F: Female.
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Volume 2 Issue 2 (2024) 3 doi: 10.36922/arnm.3041