Multinational retrospective study of stereotactic radiosurgery for craniopharyngioma

Craniopharyngioma is histologically benign yet locally aggressive, with frequent recurrence. A multinational retrospective study by the International Radiosurgery Research Foundation evaluated long-term outcomes after stereotactic radiosurgery (SRS) for craniopharyngioma. A total of 296 patients from 13 centers were included. Median age at first SRS was 33.6 years; median tumor volume was 1.32 cm³, and median margin dose was 12.0 Gy. The primary endpoint was local control (LC). Actuarial 1-, 5-, and 10-year LC was 93.5%, 76.2%, and 70.1%, respectively, whereas actuarial 1-, 5-, and 10-year overall survival was 98.2%, 93.6%, and 58.2%, and actuarial 1-, 5-, and 10-year progression-free survival was 94.2%, 73.6%, and 64.8%. Mixed solid-cystic phenotype had worse LC than non-mixed tumors; non-mixed phenotype remained independently associated with improved LC (HR 0,53; p=0.026). Visual fields improved in 10%, were unchanged in 86%, and deteriorated in 4%, whereas visual acuity improved in 6%, was unchanged in 91%, and worsened in 3%. Ten-year freedom from endocrine deterioration was 86.7%. The authors conclude that SRS achieved durable long-term LC with favorable survival outcomes and low incidence of visual and endocrinologic dysfunction.