Transient enlargement of craniopharyngioma after radiation therapy: pattern of magnetic resonance imaging response following radiation
Clinical experience suggests that craniopharyngiomas may temporarily increase in size after radiation therapy (RT). The study goal is to determine the incidence and natural history of this response in a cohort of patients managed at Children’s Healthcare of Atlanta (CHOA) or Emory Healthcare (EHC). Between 08/1998 and 06/2009, 41 children and young adults were diagnosed with craniopharyngioma at CHOA and/or EHC. Of these, 21 received external-beam radiation and were included in our analysis. Serial magnetic resonance imaging (MRI) studies were evaluated volumetrically to assess response to RT. Median age at diagnosis was 8.2 years (range 3.2–23.5 years). Median radiation dose was 54.0 Gy using standard fractionation (1.8–2.0 Gy/day). With median follow-up of 41.3 months (range 7.2–121.8 months), actuarial local control and overall survival rates at 5 years were 78.7 % and 100 %, respectively. Of subjects, 52.4 % of subjects (11 of 21) were noted on serial MRI evaluation to have tumor enlargement (mostly cystic component) after radiation before eventual shrinkage without further intervention. For tumors that expanded, the median volume increase was 33.9 % (range 15.6–224.4 %). Median time to maximal tumor/cyst expansion was 1.5 months (range 1.0–5.0 months). Finally, nearly all patients (20 of 21) showed a measurable objective response to therapy by MRI regardless of ultimate disease control. Median time to maximal response post-radiation, as defined by MRI, was 9.5 months (range 3.5–39.9 months). In summary, RT is effective for managing craniopharyngioma. However, despite good ultimate responses, approximately 50 % of the patients show tumor/cyst expansion on MRI over the first few months post-radiation. Caution should be taken not to subject these patients to “salvage surgery” or cyst aspiration during this early time unless there are other overriding surgical indications. Understanding the natural history of this phenomenon could potentially help guide the management of these craniopharyngioma patients.
KeywordsCraniopharyngioma Radiation therapy Pediatric brain tumor
Conflict of interest
Dr. Crocker receives royalties derived from Velocity Medical Solution’s sale of products. The terms of this agreement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. All other authors declare that they have no conflicts of interest.
The experiments comply with the current laws of the USA.
- 1.Beatriz M, Lopes S, Thapar K, Horvath E, Kovacs K (2006) Neoplasms of the sellar region. In: McLendon RE, Rosenblum MK, Bigner DE (eds) Russell & Rubinstein’s pathology of tumors of the nervous system, 7th edn. Hodder Arnold, London, pp 663–764Google Scholar
- 12.Stripp DC, Maity A, Janss AJ, Belasco JB, Tochner ZA, Goldwein JW, Moshang T, Rorke LB, Phillips PC, Sutton LN, Shu HK (2004) Surgery with or without radiation therapy in the management of craniopharyngiomas in children and young adults. Int J Radiat Oncol Biol Phys 58:714–720PubMedCrossRefGoogle Scholar
- 20.Merchant TE, Kiehna EN, Kun LE, Mulhern RK, Li C, Xiong X, Boop FA, Sanford RA (2006) 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. J Neurosurg 104:94–102PubMedGoogle Scholar