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Journal of Neuro-Oncology

, Volume 109, Issue 2, pp 349–355 | Cite as

Transient enlargement of craniopharyngioma after radiation therapy: pattern of magnetic resonance imaging response following radiation

  • Zheng Shi
  • Natia Esiashvili
  • Anna J. Janss
  • Claire M. Mazewski
  • Tobey J. MacDonald
  • David M. Wrubel
  • Barunashish Brahma
  • Frederick P. Schwaibold
  • Robert B. Marcus
  • Ian R. Crocker
  • Hui-Kuo G. Shu
Clinical Study

Abstract

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.

Keywords

Craniopharyngioma Radiation therapy Pediatric brain tumor 

Notes

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.

Ethical standards

The experiments comply with the current laws of the USA.

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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Zheng Shi
    • 1
  • Natia Esiashvili
    • 1
  • Anna J. Janss
    • 2
  • Claire M. Mazewski
    • 2
  • Tobey J. MacDonald
    • 2
  • David M. Wrubel
    • 3
  • Barunashish Brahma
    • 3
  • Frederick P. Schwaibold
    • 4
  • Robert B. Marcus
    • 5
  • Ian R. Crocker
    • 1
  • Hui-Kuo G. Shu
    • 1
  1. 1.Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaUSA
  2. 2.Department of PediatricsEmory University and Children’s Healthcare of AtlantaAtlantaUSA
  3. 3.Pediatric Neurosurgery Associates at Children’s Healthcare of AtlantaEmory UniversityAtlantaUSA
  4. 4.Department of Radiation OncologyPiedmont HospitalAtlantaUSA
  5. 5.Department of Radiation OncologyUniversity of Florida Proton Therapy InstituteJacksonvilleUSA

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