Craniopharyngiomas and proton beam therapy: worth the expense?

Craniopharyngiomas are intracranial tumours with a bimodal peak prevalence in childhood and in later life. Although essentially benign pathologically, craniopharyngiomas can be highly invasive, tend to recur, and are often therapeutically highly complex. 1 Apps JR Muller HL Hankinson TC Yock TI Martinez-Barbera JP Contemporary biological insights and clinical management of craniopharyngioma. Endocr Rev. 2022; (published online Dec 27.) (PMID: 36574377)DOI:10.1210/endrev/bnac035 Crossref PubMed Scopus (1) Google Scholar , 2 Cuny T Buchfelder M Dufour H et al. The challenging management of craniopharyngiomas: time for a reappraisal?. Cancers. 2022; 143831 Crossref Scopus (2) Google Scholar Additionally, hypothalamic sequelae can be highly problematic, certainly much more than for pituitary adenomas, also known as pituitary neuroendocrine tumours. Classically, the treatment of choice was radical surgery whenever possible, often transcranial, but the high morbidity associated with such surgery has led increasingly to more limited approaches, at least initially. Although the optimal surgical approach is transsphenoidal, when transcranial surgery is still necessary, radical removal is now rarely attempted when possible, and any residual disease is treated with some form of radiotherapy. 1 Apps JR Muller HL Hankinson TC Yock TI Martinez-Barbera JP Contemporary biological insights and clinical management of craniopharyngioma. Endocr Rev. 2022; (published online Dec 27.) (PMID: 36574377)DOI:10.1210/endrev/bnac035 Crossref PubMed Scopus (1) Google Scholar , 2 Cuny T Buchfelder M Dufour H et al. The challenging management of craniopharyngiomas: time for a reappraisal?. Cancers. 2022; 143831 Crossref Scopus (2) Google Scholar Proton therapy and limited surgery for paediatric and adolescent patients with craniopharyngioma (RT2CR): a single-arm, phase 2 studyProton therapy did not improve survival outcomes in paediatric and adolescent patients with craniopharyngioma compared with a historical cohort, and severe complication rates were similar. However, cognitive outcomes with proton therapy were improved over photon therapy. Children and adolescents treated for craniopharyngioma using limited surgery and post-operative proton therapy have a high rate of tumour control and low rate of severe complications. The outcomes achieved with this treatment represent a new benchmark to which other regimens can be compared. Full-Text PDF