Online citations, reference lists, and bibliographies.
← Back to Search

A Quantitative Analysis Of Craniopharyngioma Cyst Expansion During And After Radiation Therapy And Surgical Implications.

Kelly Lamiman, K. Wong, B. Tamrazi, Jason D. Nosrati, A. Olch, E. Chang, E. Kiehna
Published 2016 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
OBJECTIVE When complete resection of craniopharyngioma is not achievable or the sequelae are prohibitive, limited surgery and radiation therapy have demonstrated excellent local disease control while minimizing treatment-related sequelae. When residual tissue exists, there is a propensity for further cyst development and expansion during and after radiation therapy. This can result in obstructive hydrocephalus, visual changes, and/or clinical decline. The authors present a quantitative analysis of cyst expansion during and after radiotherapy and examine how it affected subsequent management. METHODS The authors performed an institutional review board-approved retrospective study of patients with histologically confirmed craniopharyngioma treated between 2000 and 2015 with surgery and intensity-modulated radiation therapy (IMRT) at a single institution. Volumetric measurements of cyst contours were generated by radiation oncology treatment planning software postoperatively, during IMRT, and up to 12 months after IMRT. Patient, tumor, and treatment-related variables were collected until the last known follow-up and were analyzed. RESULTS Twenty-seven patients underwent surgery and IMRT. The median total radiation dose was 54 Gy. Of the 27 patients, 11 patients (40.7%) demonstrated cyst expansions within 1 year of IMRT. Of note, all tumors with cyst expansion were radiographically Puget Grade 2. Maximal cyst expansion peaked at 4.27 months following radiation therapy, with a median volume growth of 4.1 cm3 (mean 9.61 cm3) above the postoperative cyst volume. Eight patients experienced spontaneous cyst regression without therapeutic intervention. Three patients experienced MRI-confirmed cyst enlargement during IMRT, all of whom required adaptive planning to ensure adequate coverage of the entire tumor volume. Two of these 3 patients required ventriculoperitoneal shunt placement and additional intervention. One underwent additional resection, and the other had placement of an intracystic catheter for aspiration and delivery of intracystic interferon within 12 months of completing IMRT. All 3 patients now have stable disease. CONCLUSIONS Craniopharyngioma cyst expansion occurred in approximately 40% of the patients during or after radiotherapy. In the majority of patients, cyst expansion was a self-limiting process and did not confer a worse outcome. During radiotherapy, cyst expansion may be apparent on image-guided radiation therapy. Adaptive IMRT planning may be required to ensure that the intended IMRT dose covers the entire tumor and cyst volume. The sequelae of cyst expansion include progressive hydrocephalus, which may be treated with a shunt. For patients with solitary cyst expansion, cyst aspiration and/or intracystic interferon may result in disease control.
This paper references
10.3171/PED.2007.106.1.3
Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement.
S. Puget (2007)
10.3389/fendo.2012.00039
Intracystic Therapies for Cystic Craniopharyngioma in Childhood
U. Bartels (2012)
10.1007/s00381-010-1245-4
The role of inflammation in the genesis of the cystic component of craniopharyngiomas
B. Pettorini (2010)
10.1002/pbc.22884
Long‐term clinical outcomes following treatment of childhood craniopharyngioma
K. Winkfield (2011)
10.1007/s00381-005-1188-3
Radiation therapy in the management of pediatric craniopharyngiomas—a review
J. Kalapurakal (2005)
10.1016/j.ijrobp.2011.01.005
On the benefits and risks of proton therapy in pediatric craniopharyngioma.
C. Beltran (2012)
10.1016/j.ijrobp.2008.05.010
Surveillance of craniopharyngioma cyst growth in children treated with proton radiotherapy.
K. Winkfield (2009)
10.1016/j.ijrobp.2014.05.051
Proton beam therapy versus conformal photon radiation therapy for childhood craniopharyngioma: multi-institutional analysis of outcomes, cyst dynamics, and toxicity.
A. Bishop (2014)
10.1016/S0360-3016(03)01570-0
Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults.
D. Stripp (2004)
10.1016/J.IJROBP.2006.07.494
Abstract2091: Shape Variability of Craniopharyngioma as Measured on CT-on-Rails During Radiotherapy Treatment
David G. Kornguth (2006)
10.3171/PED.2006.104.2.94
Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function
T. Merchant (2006)
10.1002/1097-0142(197604)37:4<1944::AID-CNCR2820370446>3.0.CO;2-#
Craniopharyngiomas. A clinical and pathological review
C. Petito (1976)
10.3171/2010.1.FOCUS09297
Radiation therapy for pediatric craniopharyngioma.
E. Kiehna (2010)
10.1016/j.radonc.2010.10.017
Dosimetric effect of target expansion and setup uncertainty during radiation therapy in pediatric craniopharyngioma.
C. Beltran (2010)
10.1007/s11060-012-0900-x
Transient enlargement of craniopharyngioma after radiation therapy: pattern of magnetic resonance imaging response following radiation
Zheng Shi (2012)
10.3171/2014.10.PEDS14384
Recurrent craniopharyngioma after conformal radiation in children and the burden of treatment.
Paul Klimo (2015)
10.1227/00006123-198901000-00008
Craniopharyngiomas: fluctuation in cyst size following surgery and radiation therapy.
L. Constine (1989)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar