Evaluation of the role of external radiation therapy following percutaneous drainage using stereotactically implanted Ommaya reservoir system in the management of grossly cystic Craniopharyngioma

Eman El-Sheikh, Ashraf Al-Abyad
2010 Research in Oncology  
A prospective study to evaluate the effectiveness, safety and toxicity of radiation therapy (RT) following percutaneous drainage using Ommaya reservoir system (ORS) stereotactically implanted as a therapeutic option in the management of cystic craniopharyngioma. patients and methods: Between January 2000 and August 2008, 30 patients were referred for stereotactic placement of ORS for drainage of their cystic craniopharyngiomas. There were 16 males and 14 females vary in age from 752-years
more » ... rom 752-years (median 15years).Sex patients (20%) had ORS placement as a primary treatment, while 24 patients (80%) had undergone prior craniotomy. Twelve patients (40%) had purely cystic tumors, while 18 patients (60%) had mixed tumors. Patients were selected on the basis of having their CT scan and MRI disclosure of:1) Purely or predominantly unilocular cystic Craniopharyngioma, either primary or recurrent. 2)The craniocaudal dimension of the cyst was at least 2cm. 3)The cyst wall was not too thick or calcified to be punctured. All patients received RT.A median target dose of 52.2Gy (range 5057.6-Gy) was applied in a conventional fractionation of 1.8 Gy for 5 days per week. results: Twenty-five patients (83.3%) showed clinical improvement in the early post-operative period. No procedure related morbidity was encountered. Eleven patients (36.6%) had spontaneous regression of their cysts, 16 patients (53.3%) required multiple aspiration for symptomatic recurrence of their cysts; 11(68.7%) of them finally stabilized and the remaining 5(31.2%) patients continued to require infrequent aspiration at intervals ranged from 4 months to one year. Three patients (10%) required frequent aspiration every one to 2 weeks even after finishing a complete course of RT. Three patients (10%) eventually required revision of their ORS. Five patients (16.6%) necessitated subsequent craniotomy. After a median follow-up of 48 months (range 1270-months), local tumor control was 90% at 5-years.Overall survival and progression free survival rates at 5-years were 90% and 86.6%, respectively. Acute toxicity was mild in all patients. Long-term toxicity included growth hormone deficiency in 5 patients (16.6%) requiring hormonal replacement therapy. No radionecrosis or secondary malignancy were observed. conclusion: Treatment of cystic craniopharyngiomas by percutaneous aspiration via ORS implanted stereotactically combined with RT can be considered as a definitive treatment option in cases of recurrent grossly cystic or primary purely cystic tumors.
doi:10.21608/resoncol.2010.413 fatcat:kgjzllyp5vbpxoxsknatw4scoa