Endocrine Abstracts

The optimum management of patients with craniopharyngiomas is controversial. Evidence relies on a small number of retrospective outcome surveys that encompass time periods that are not necessarily representative of current surgical techniques and imaging modalities. We have reviewed outcome in a more contemporary group of patients managed at a single centre.

Case-notes and electronic data were reviewed of all patients treated for craniopharyngioma since 1980. N=66, 53% female; average age: 40.3±20.3yrs (59 patients >16 years); average follow-up: 10.1±6.6yrs. 67% of patients were treated with surgery alone and 33% received radiotherapy (22 surgery+radiotherapy, 2 radiotherapy alone). One patient received neither. Overall 5-year survival was 80% and age at time of first surgery was an over-riding factor: 5-year survival <30 years was 100%, <50 years 89%, and >50 years 59% (P=0.004 for <30yrs/>30yrs; P=0.002 for <50yrs/>50yrs). Application of radiotherapy did not influence 5 year survival: 83% who received radiotherapy survived 5yrs vs 77% who did not. In the subgroup of those with tumour remnant post-operatively who were administered radiotherapy, figures were 82% and 67% respectively (P=N/S). Rate of tumour re-growth was lower in those who received radiotherapy (20% vs 43%, P=N/S). 31% of patients had no evidence of residual tumour on initial post-operative scan and 5 year survival in this group was100% compared with 72% for those with an identified residuum (P=0.042). Hormone deficiencies were more common in those who had received RT (91% of axes tested vs 73%, P=0.002).

In this contemporary series of patients with craniopharyngioma, major determinants of mortality were age at surgery and presence of residual tumour on initial post-operative scan. The reduction in re-growth after radiotherapy did not reach statistical significance and the administration of radiotherapy did not significantly reduce mortality. Pituitary hormone deficiencies were more common in those who had received radiotherapy.