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The Role of Definitive Radiotherapy in Craniopharyngioma: A SEER Analysis

Zhang, Chi, MD, PhD*; Verma, Vivek, MD*; Lyden, Elizabeth R., MS; Horowitz, David P., MD; Zacharia, Brad E., MD, MS§; Lin, Chi, MD, PhD*; Connolly, Eileen P., MD, PhD

American Journal of Clinical Oncology: August 2018 - Volume 41 - Issue 8 - p 807–812
doi: 10.1097/COC.0000000000000378
Original Articles: Central Nervous System

Objective: Assess patterns of care in the management of craniopharyngioma, especially with respect to the use of radiation therapy (RT) alone (which has been understudied to date) as compared with gross total resection (GTR) and subtotal resection (STR) with adjuvant RT.

Materials and Methods: The epidemiology, treatment modalities, and outcomes of patients with craniopharyngioma were studied using the Surveillance Epidemiology and End Results (SEER) database from 2004 to 2012. Survival was compared between treatment groups using Kaplan-Meier analysis and log-rank tests.

Results: In total, 1218 patients with craniopharyngioma were identified, with equal distribution across sex. There were bimodal incidence peaks, one 20 years old or below, and the other between 40 and 65 years. The majority of pediatric tumors with known histology were adamantinomatous type, which did not influence outcomes when adjusting for age (P=0.392). Overall survival/cause-specific death for patients that underwent RT, STR+RT, and GTR were not statistically different (P>0.05). There was improved survival between several modalities: RT only versus STR only (P=0.024), RT only versus observation (P=0.006), STR+RT versus observation (P=0.046), and GTR versus observation (P=0.046). Patients above 65 years old were more likely to undergo observation (P=0.002), with highest proportions of surgery (54%)/RT (21%) in the pediatric population. Multivariable analysis demonstrated that though age was associated with overall survival (P<0.001), treatment modality (RT/GTR/STR+RT) was not (P=0.119).

Conclusions: Although management of craniopharyngioma remains somewhat controversial, there were no observed differences in outcomes between definitive RT, GTR, and STR+RT. Although these data are hypothesis-generating, additional data are needed to validate these findings.

*Department of Radiation Oncology, University of Nebraska Medical Center

Department of Biostatistics, College of Public Health, University of Nebraska, Omaha, NE

Department of Radiation Oncology, Columbia University Medical Center, New York, NY

§Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA

The authors declare no conflicts of interest.

Reprints: Eileen P. Connolly, MD, PhD, Department of Radiation Oncology, Columbia University Medical Center, 622 W 168th St., CHONY North Basement, Room 11, New York, NY 10032. E-mail:

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