ИСТИНА

Objective: Craniopharyngiomas (CPh) are the most common non-glial tumors in children. According to many trials of Stereotactic Radiation Therapy (SRT) and Radiosurgery (SRS) yield a long recurrence-free survival or help to prevent progression in patients with unresectable and recurrence CPh. We retrospectively reviewed the experience of Burdenko Institute to determine the role of Stereotactic Irradiation in complex treatment of these patients. Methods: 266 patients with craniopharyngiomas were treated with different types of stereotactic irradiation between 1.2005 and 12.2016 at Burdenko Neurosurgical Institute and Moscow GammaKnife Centre. This is the analysis of the results of treatment of 123 children (under the age of 18) with data of follow up. Were irradiated 88 patients (72%) with residual tumors and 35 patients (28%) with relapses. The study group consisted of 74 boys and 49 girls. The median age was 10,7 years. All the patients had a prior tumor resection. 55 patients underwent SRT / Novalis/ (mean dose 54 Gy), 44 patients underwent hypofractionated irradiation /CyberKnife/ (5fr x 5-5,5Gy, 3 fr x 7Gy) and 24 pts - SRS with GammaKnife (mean dose 16 Gy; average PD=13.5 Gy (8 - 16 Gy), average PI=49.3% (33.3 - 60%). Totally 42 tumors or tumor fragments was treated 44 times. Average tumor volume - 1.7 cm3 (0.07 - 4.89 cm3)). Results: The median follow-up period was 92,9 months (range, 16,9-255) after the patients were diagnosed. All of these patients (123 pts-100%) were available for the follow-up. At the end of the follow-up (6.2017) 118 patients (95,9%) were alive. 5-year OS was 99%. The median follow-up period after irradiation was 38 months (range, 0,13-129). Tumor control or regression was achieved in 112 patients (91%). 9 patients (7%) had a transient enlargement of cysts at early time of irradiation: on average 3,5 month (range 2,7-9,4). There were no statistical differences in the effectiveness of different types of fractionation. Conclusions: Stereotactic radiosurgery, radiotherapy and hypofractionation are effective methods of treatment for CPh in patients with residual tumors, as well patients with CPh relapses with progressive disease without difference in results. The enlargement of craniopharyngioma cysts in early time (not later than 1 year) after irradiation usually is transient and do not require surgical treatment.