Long-Term Experience of Craniopharyngioma Treatment in Single University-Based Hospital

Abstract Purpose Craniopharyngioma is a relatively rare disease. Multimodality of treatment is still a challenge due to recurrence and treatment-related toxicities. While long-term treatment data in Thailand is still limited, this study aims to report 30 years of experience in craniopharyngioma treatment in a single institute. Methods Retrospective study includes all patients diagnosed with craniopharyngioma between January 1990 and January 2020. Demographic data and treatment outcomes were collected and analyzed. Results Ninety-eight patients were included in the analysis with a median age at diagnosis of 20.5 years (1–67 years). The majority of patients received surgical resection (98%). However, only 13.3% achieved gross total resection, and 8.2% received postoperative radiotherapy. With a median follow-up interval of 8.5 years (1–33 years), a 5-year progression-free survival rate was 39.3%. The median time to progression was 2.4 years. Whereas adjuvant radiotherapy was the only factor shown to be beneficial (HR 0.21, 95% CI 0.05–0.22, p = 0.03), Intra-cystic chemotherapy without any resection resulted in a detrimental outcome (HR 70.12, 95% CI 9.67-508.14, p = 0.03). However, overall survival rates remained high, 100% at 5 years. Radiotherapy still showed a favorable outcome at any course of the treatment. Five-year radiotherapy failure-free survival (RT-FFS) rate was 81.4%. Late endocrine dysfunction, especially hypothyroidism (96%), and delayed puberty (77.8%), obesity (69.2%), and visual field defect (43.1%) were common. Conclusion The multimodality treatment in craniopharyngioma has yielded promising survival rates, but disease progression is still challenging. Radiotherapy is effective in tumor control in both adjuvant and salvage settings. However, long-term toxicities should be carefully considered.