Page 42 - ARNM-2-2

Advances in Radiotherapy
& Nuclear Medicine Hypofractionated radiotherapy in craniopharyngioma

5 years. 10,11 Iannalfi et al. have conducted a review on the event-free survival was statistically higher with the use of
use of RT in craniopharyngioma. The studies analyzed modern imaging techniques and doses of 55 Gy and above.
3
12
used conventional RT schemes, including two-dimensional All patients in this study received RT using megavoltage
and three-dimensional RT, as well as fractionated SRT machines; Cobalt 60 in 16 (43%), 4 MV X-rays in 6, and
techniques. The doses applied ranged from 42.5 to 62.4 Gy, ≥17 MV X-rays in 15 patients. Total dose ranged between
with a dose of 1.8 – 2 Gy per fraction. The 5-year PFS or 45 and 56 Gy (median 50), and target volume consisted
local control rates varied between 75% and 100%. Our of GTV with a safety margin of 2 cm in each diameter.
study found a 5-year PFS rate of 85.7%, which is consistent In most cases (63%), simple beams setting through two-
with the literature, suggesting that HFRT provides opposed parallel beams were used. For some patients
tumor control similar to conventional fractionation. with tumors located above the base of the skull, multiple
12
Therefore, even with older technology, RT outcomes for beams technique (27%) were used. Field size varied from
craniopharyngioma remain satisfactory. 5 × 5 cm to 11 × 12 cm (median 6 × 6 cm). In this study,
the field size utilized was much smaller and the margins
Dose, patient, and survival characteristics of the studies
in discussion and the present study are tabulated in Table 2. much narrower, significantly reducing harmful irradiation
onto normal tissue, since the advanced RT techniques
Habrand et al. reported on the long-term results of applied can deliver a much precise focus on the target
RT treatment, administered between 1969 and 1992, for lesion. In Habrand et al.’s study, the rates of endocrine,
craniopharyngioma in 37 children, and emphasized that visual, and neurological dysfunctions were found in 97%,

Table 2. Patient, treatment, and survival characteristics of studies discussed
Reference Total Median age Radiotherapy Median dose (range LC or PFS OS
no. patient (range in years) technique in Gy)
number
Current 8 14 (4 – 26) • Helical IMRT 22 (22 – 25) at 5 85.7% at 5 years 85.7% at 5 years
study • CKS fractions and 42
(40 – 55) at 15-30
fractions
3 37 Mean 7.4 (1 – 15) CRT with Cobalt 50 (45 – 56) 78% at 5 years, 91% at 5 years
or LINAC 65% at 10 years 65% at 10 years
with dose ≥55 Gy
79% at 5 years,
45% at 10 years with
dose <55 Gy
7 242 41 (3 – 86) GKS Mean marginal dose 62% at 5 years 93% at 5 years
11.4 (8 – 20.4) 43% at 10 years 82% at 10 years
11 61 7.5 years CRT with LINAC 54.6 (50.4 – 65.9) 100% at 10 years (RT alone) 91% at 10 years
(10 months to 21 86% at 10 years (S+RT)
years)
13 58 8 (3-16) for CRT with Cobalt • Mean 55.8 • 56% with dose 54 Gy • 84% at 5 years; 72% at
children (52.5 – 65.2) for • 84% with dose >55 Gy 10 years for children
45 (18-64) for children • 54% at 5 years; 51% at
adults • Mean 62.4 10 years for adults
(43.2 – 70) for
adults
23 53 53 (22 – 76) • CRT 50 (45 – 54) at 20 – 28 85% at 5 years 76% at 5 years
• Stereotactic arc fractions 69% at 10 years 70% at 10 years
• Stereotactic IMRT
25 30 8.6 (1 – 15) • CRT 20 – 22 to 54 – 55.8 67% at 5 years 83% at 5 years
• Coplanar Arc
• Stereotactic
26 16 Mean 34.5 CKS Mean marginal dose No data No data
(13 – 71) 21.6 (18 – 38) at
3 – 10 fractions
Abbreviations: CRT: Conventional radiotherapy; CKS: CyberKnife surgery; GKS: Gamma Knife surgery; IMRT: Intensity-modulated radiotherapy;
LC: Local control; OS: Overall survival; PFS: Progression-free survival; 2D: Two-dimensional.

Volume 2 Issue 2 (2024) 5 doi: 10.36922/arnm.3041