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Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children

Stereotaktische, intrakavitäre Brachytherapie mit P-32 zur Behandlung zystischer Kraniopharyngeome bei Kindern

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Abstract

Purpose

Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP.

Patients and methods

Between 1992 and 2009, 17 children (median age 15.4 years; range 7–18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid–cystic lesions (median tumor volume 11.1 ml; range 0.5–78.9 ml). The median follow-up time was 61.9 months (range 16.9–196.6 months).

Results

Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3–10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively.

Conclusion

Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations.

Zusammenfassung

Zielsetzung

Obwohl die Mikrochirurgie die Methode der Wahl darstellt, ist die komplette Resektion zystischer Kraniopharyngeome häufig mit einer signifikanten Morbidität und Mortalität assoziiert. Darüber hinaus zeigte eine additive externe Bestrahlung zur subtotalen Resektion ähnliche Ergebnisse. Es bestehen jedoch weiterhin Bedenken bezüglich der Langzeitmorbidität nach externer Bestrahlung bei Kindern. Mit dieser retrospektiven Studie wollen die Autoren die intrakavitäre Brachytherapie mit radioaktivem Phosphor-32 (P-32) als eine Behandlungsoption bei Kindern mit zystischen Kraniopharyngeomen hervorheben.

Patienten und Methoden

Zwischen 1992 und 2009 wurden 17 Kinder (medianes Alter 15,4 Jahre; Spanne 7–18 Jahre) mit zystischen Kraniopharyngeomen durch eine intrakavitäre Brachytherapie mit P-32 behandelt. Insgesamt 11 Patienten wurden aufgrund rezidivierender Tumorzysten, 6 Patienten primär behandelt. MRT-Aufnahmen zeigten solitäre Zysten bei 7 Patienten, während 10 Patienten gemischt solide-zystische Läsionen aufwiesen (medianes Tumorvolumen 11,1 ml; Spanne 0,5–78,9 ml). Die mediane Nachbeobachtungszeit betrug 61,9 Monate (Spanne 16,9–196,6 Monate).

Ergebnisse

Eine lokale Kontrolle der Tumorzyste konnte bei 14 Patienten erreicht werden (82 %). Bei 3 Patienten zeigte sich ein Progress der behandelten Zysten („in-field progression“) nach einer medianen Nachbeobachtungszeit von 8,3 Monaten (Spanne 5,3–10,3 Monaten), was nachfolgende Interventionen notwendig machte. Die Entwicklung neuer Zysten sowie die Progression solider Tumoranteile („out-of-field progression“) konnten bei 5 Patienten nachgewiesen werden. Dies führte zu weiteren Behandlungen in 4 Fällen. Es bestand weder eine operationsbedingte permanente Morbidität noch Mortalität. Das progressionsfreie Überleben betrug 75, 63 und 52 % nach 1, 3 und 5 Jahren.

Schlussfolgerung

Die intrakavitäre Brachytherapie mit P-32 stellt eine sichere und effektive Behandlungsoption für Kinder mit zystischen Kraniopharyngeomen, sogar als Primärtherapie, dar. Jedoch zeigt sich kein eindeutiger Effekt auf solide Tumoranteile, sowie auf die Entwicklung neuer Tumorzysten.

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Acknowledgments

The authors FE, VS, and MM were at the Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne during conceptualization, collection, and evaluation of the study data and moved to different institutions thereafter.

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Authors and Affiliations

  1. Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany

    Mohammad Maarouf M.D., Faycal El Majdoub M.D., Mauritius Hoevels &  Volker Sturm M.D.

  2. Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Mohammad Maarouf M.D. & Faycal El Majdoub M.D.

  3. Department of Neurosurgery, University Hospital of Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Manuel Fuetsch M.D.

  4. Department of Stereotaxy and Functional Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Germany

    Ralph Lehrke M.D.

  5. Department Pediatric Oncology, University Hospital of Cologne, Kerpener Strasse 62, 50938, Cologne, Germany

    Frank Berthold M.D.

  6. Department of Stereotaxy and Functional Neurosurgery, University Hospital of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Jürgen Voges

  7. Department of Neurosurgery, University Hospital of Wurzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany

    Volker Sturm M.D.

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  1. Mohammad Maarouf M.D.
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  2. Faycal El Majdoub M.D.
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  3. Manuel Fuetsch M.D.
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  5. Ralph Lehrke M.D.
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  6. Frank Berthold M.D.
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  8. Volker Sturm M.D.
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Corresponding authors

Correspondence to Mohammad Maarouf M.D. or Faycal El Majdoub M.D..

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Conflict of interest

M. Maarouf, F. El Majdoub, M. Fuetsch, M. Hoevels, R. Lehrke, F. Berthold, J. Voges, and V. Sturm state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Maarouf, M., Majdoub, F., Fuetsch, M. et al. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children. Strahlenther Onkol 192, 157–165 (2016). https://doi.org/10.1007/s00066-015-0910-7

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