The optimum management of patients with craniopharyngiomas is controversial. Evidence relies on a small number of retrospective outcome surveys that encompass time periods that are not necessarily representative of current surgical techniques and imaging modalities. We have reviewed outcome in a more contemporary group of patients managed at a single centre.
Case-notes and electronic data were reviewed of all patients treated for craniopharyngioma since 1980. N=66, 53% female; average age: 40.3±20.3yrs (59 patients >16 years); average follow-up: 10.1±6.6yrs. 67% of patients were treated with surgery alone and 33% received radiotherapy (22 surgery+radiotherapy, 2 radiotherapy alone). One patient received neither. Overall 5-year survival was 80% and age at time of first surgery was an over-riding factor: 5-year survival <30 years was 100%, <50 years 89%, and >50 years 59% (P=0.004 for <30yrs/>30yrs; P=0.002 for <50yrs/>50yrs). Application of radiotherapy did not influence 5 year survival: 83% who received radiotherapy survived 5yrs vs 77% who did not. In the subgroup of those with tumour remnant post-operatively who were administered radiotherapy, figures were 82% and 67% respectively (P=N/S). Rate of tumour re-growth was lower in those who received radiotherapy (20% vs 43%, P=N/S). 31% of patients had no evidence of residual tumour on initial post-operative scan and 5 year survival in this group was100% compared with 72% for those with an identified residuum (P=0.042). Hormone deficiencies were more common in those who had received RT (91% of axes tested vs 73%, P=0.002).
In this contemporary series of patients with craniopharyngioma, major determinants of mortality were age at surgery and presence of residual tumour on initial post-operative scan. The reduction in re-growth after radiotherapy did not reach statistical significance and the administration of radiotherapy did not significantly reduce mortality. Pituitary hormone deficiencies were more common in those who had received radiotherapy.
01 - 05 Apr 2006
European Society of Endocrinology